New York City Found Not to Properly Follow Procedures to recover Medicaid Overpayments

March 3, 2020

Proper Procedure for Recovery of Medicaid Overpayment

Over 72.5 million Americans have Medicaid, a joint federal and state program that provides health coverage to qualified individuals. Applicants must provide documentation of their identity, income, and residency. Those who live outside the state of New York are not eligible for New York Medicaid and those who move to another state while receiving benefits may have their benefits terminated.

Procedural Requirements for Termination of Medicaid Benefits

Under New York law, for social services agencies to discontinue or otherwise take action to amend an individual’s Medicaid benefits, they must give timely notice in the form of written correspondence to the Medicaid recipient. Written notice of such intent must be mailed at least 10 days prior to the effective date of the proposed action.

When payments are made to ineligible persons, Social Services Law mandates that agencies take all necessary steps to correct such overpayments in accordance with the regulations of the department, such as providing proper notice of the agency’s claim and the individual’s right to a hearing. Failure to follow such administrative procedures implicates the subject matter jurisdiction of the court; any judgments or orders rendered by a court without subject matter jurisdiction are void.

New York HRA v. Hewitt

In a case recently published in the New York Law Journal, on February 20 ,2020, the City of New York Human Resources Administration (HRA) sought to recover Medicaid funds it allegedly provided to the defendant during the time he was residing outside New York State. An administrative law judge of the New York Department of Health (DOH) found the plaintiff’s notice of intent did not comply with governing administrative regulations for several reasons, including that it had not been mailed at least 10 days prior to the effective date of the proposed action. The HRA subsequently filed an appeal.

The Appellate Term held that the Medicaid recipient’s motion to dismiss on the merits based on documentary evidence allegedly establishing his residency in New York during the time in question was barred because he had already answered the plaintiff’s complaint. However, motions to dismiss based on lack of subject matter jurisdiction may be made at any time, therefore the defendant’s motion to dismiss based on the plaintiff’s failure to follow prescribed administrative procedures was granted.

Although the defendant’s motion to dismiss the HRA’s complaint was initially denied by the lower court, the Appellate Term reversed that order and granted the defendant’s motion to dismiss based on the HRA’s improper attempt to circumvent fair hearing procedures and failure to comply with statutory requirements pertaining to the recovery of overpayments. This means that HRA improperly circumvented the procedures in recovering Medicaid payments HRA felt was not properly due.

New York Elder Law Attorneys at Korsinsky & Klein, LLP Protect Medicaid Recipients’ Rights

If your Medicaid coverage was denied, suspended, reduced, or terminated, or you were ruled ineligible for Medicaid, contact a New York elder law attorney at Korsinsky & Klein, LLP. Our skilled and experienced attorneys can represent you in a fair hearing and ensure that your rights are protected. Located in Brooklyn, and Manhattan, New York, as well as Lakewood New Jersey, we serve clients throughout New York State. To discuss your case, contact us online or call us at 212-495-8133.