Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Appellate Division
SUBJECT: Indiana Department of
DATE: June 26, 1990
Public Welfare Docket No. 90-77
Decision No. 1169
DECISION
The Indiana Department of Public Welfare (State) appealed a
determination by the Health Care Financing Administration (HCFA)
disallowing $492,754 in federal financial participation claimed by the
State under title XIX of the Social Security Act for the period April 1,
1985 through June 30, 1988. The disallowance was based on a follow-up
audit by the Office of Inspector General of Medicaid payments for
services provided in community residential facilities (CRFs). HCFA
determined that 13 CRFs were improperly certified and ineligible to
participate in the Medicaid program.
In Indiana Dept. of Public Welfare, DAB No. 970 (1988), the Board
determined that (1) there was substantive legal authority for insisting
that patients be present in a facility at the time it is surveyed; (2)
there was an adequate factual basis to support the auditors' findings
that facilities were certified prior to being operational and treating
patients; and (3) it was appropriate for HCFA to disallow payments made
to the facilities. As a result, the Board sustained the disallowance.
Because the issues in this appeal appeared to have been addressed by the
Board in Indiana, the Board proposed to issue a summary decision in this
appeal based on Indiana unless the State showed good cause why that
decision was not controlling. The State was asked to specify in what
ways this appeal might be different factually and legally. The State
did not respond in writing to the Board's Order to Show Cause; by
telephone, however, the State indicated that it did not have a response
to the Order and had no objection to the Board issuing a summary
decision based on Indiana. Since the State has not shown that this
appeal is different factually or legally from DAB No. 970, we sustain
the Agency's disallowance in the amount of $492,754, based on Decision
No. 970, which we incorporate by reference.
Judith A. Ballard
Donald F. Garrett
Alexander G. Teitz Presiding Board