Justia Wisconsin Supreme Court Opinion SummariesArticles Posted in Public Benefits
Papa v. Wisconsin Department of Health Services
In this case requiring the Supreme Court to determine the scope of the authority of the Wisconsin Department of Health Services (DHS) to recoup payments made to Medicaid service providers the Supreme Court held that DHS does not have the authority to enforce its recoupment policy.Plaintiffs, Kathleen Papa and Professional Homecare Providers, Inc. (collectively, PHP), challenged DHS's recoupment policy as it had been enforced against PHP nurses to recover payments made for services they provided to Medicaid patients. PHP claimed that DHS recoups payments nurses earned and received for their Medicaid services because the nurses' supporting records contained documentation shortcomings. The Supreme Court held (1) DHS may recoup Medicaid payments from service providers only in cases where DHS cannot verify certain facts; and (2) DHS's recoupment policy exceeds its authority. View "Papa v. Wisconsin Department of Health Services" on Justia Law
Gister v. Am. Family Mut. Ins. Co.
In this case the Supreme Court was asked to decide whether a charitable hospital may pursue payment for medical care provided to a Medicaid-eligible patient by filing a lien against a settlement between the patient and an insurance company covering the liability of a tortfeasor responsible for the patient's injuries. To answer the question, the Court balanced the complex state and federal legal framework surrounding Medicaid with Wis. Stat. 779.80 (hospital lien statute). The Court concluded that the soundest harmonization of the two permitted the liens at issue here. In so doing, the Court reversed the court of appeals, which reversed the circuit court's reasoning that the hospital was authorized to either file the liens or bill Medicaid. View "Gister v. Am. Family Mut. Ins. Co." on Justia Law
State v. Abbott Labs.
The State brought a civil action against Pharmacia Corporation, alleging that the company reported inflated drug prices to Wisconsin Medicaid. A jury found Pharmacia liable for violating the Deceptive Trade Practices Act (DTPA) and the Medicaid fraud statute. The jury awarded the State $2 million for the DTPA claim and $7 million for the Medicaid fraud claim. The jury also determined that Pharmacia committed 1,440,000 separate violations of the Medicaid fraud statute. In post-trial proceedings, the circuit court reduced the number of violations to 4,578. Both parties appealed. The court of appeals certified three issues to the Supreme Court. The Court affirmed the circuit court's judgment on the issues and remanded to the court of appeals, holding (1) the State was entitled to a jury trial on its Medicaid fraud claim; (2) the jury did not impermissibly speculate in determining the damage award; and (3) the circuit court properly reduced the number of violations found by the jury. View "State v. Abbott Labs." on Justia Law