GREYNOLDS PARK MANOR, INC., APPELLANT,
v.
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES, APPELLEE
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Greynolds Park Manor, a nursing home participating in Florida's Medicaid reimbursement program, appeals an administrative order requiring it to repay excess Medicaid reimbursements identified in HRS audits. The First District Court of Appeal affirmed the agency's decision, holding that the nursing home failed to meet its burden of proving entitlement to the disputed amounts for pension plan and automobile expenses.
The court affirmed the administrative order requiring repayment. The agency properly placed the burden on the nursing home to demonstrate entitlement to the disputed reimbursements, which it failed to do. The hearing officer also properly declined to address the estoppel issue as premature, since that question should be raised in conjunction with the rate request itself.
[1] A nursing home participating in a state's long-term care reimbursement plan bears the burden of proving its entitlement to disputed Medicaid reimbursements during an audi…
[2] An administrative agency may permissibly defer consideration of an estoppel issue until a hearing for which proper application has been made, even if the issue is raised…
Previewing 2 of 3 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“the burden was upon appellant to show entitlement to the disputed monies”
Establishes that the nursing home, not the agency, bore the burden of proving it was entitled to the reimbursements in question
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceGreynolds Park Manor is a nursing home participating in Florida's Long Term Care Reimbursement Plan for Medicaid payments. In September and November 1…
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WENTWORTH, Judge.
Appellant seeks review of an administrative order by which it is required to repay the Department of Health and Rehabilitative Services (hereinafter “HRS” or “the agency”) for excess Medicaid reimbursements. We affirm the order appealed.
Appellant is a nursing home participating in the Florida Long Term Care Reimbursement Plan, by which Medicaid payments are received as reimbursement for allowed costs. In September and November 1982 HRS furnished appellant with an audit report and management letter indicating that appellant had received Medicaid overpay-ments for fiscal years ending in May 1979 and May 1981. Appellant disputed the audit adjustments and requested a formal hearing pursuant to § 120.57(1), Florida Statutes. Appellant also applied for an interim rate increase applicable between June 1979 and October 1980.
Appellant’s petition for a hearing disputed audit adjustments relating to a pension plan and automobile expenses, and appellant further sought a determination that HRS should be estopped from denying an interim rate increase. The hearing officer, in an order adopted by the agency, declined to address the merits of the estoppel issue, reasoning that “since the estoppel question should be raised in conjunction with the rate request ... it is premature to consider that issue.” The hearing officer further noted that appellant’s interim rate request was still pending at the time the petition for a hearing was filed. Although HRS did thereafter act on the rate request prior to the formal hearing, and the parties alluded to the estoppel issue at the hearing, the circumstances presented did not require a determination on the merits thereof. Rather, the agency could permissibly await presentation of the issue at a hearing for which proper application is made.1
As to the pension plan and automobile expenses, the burden was upon appellant to show entitlement to the disputed monies. Rule 100-7.481(6), FAC; cf,, Florida Department of Transportation v. JWC Co., Inc., 396 So. 2d 778 (Fla. 1st DCA 1981). We find that, on the record presented, HRS was entitled to conclude that appellant did not meet this burden with regard to the challenged audit adjustments. It was therefore not error to require that appellant repay the disputed Medicaid reimbursements.
The order appealed is affirmed.
ERVIN, C.J., and BOOTH, J., concur. . In the adopted order the hearing officer suggested that appellant should still be entitled to challenge the denial of its interim rate request. In this regard the order references Henry v. State Department of Administration, 431 So. 2d 677 (Fla. 1st DCA 1983), and notes that HRS "failed to inform [appellant] of his right to request a hearing, and the time limits for doing so
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Citator
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Greynolds Park Manor, Inc. v. Dep't of Health & Rehabilitative Servs., 491 So. 2d 1157 (Fla. 1st DCA 1986)…ng therefore addressed only audit adjustments relating to a pension plan and automobile expenses. The final order held that Grey-nolds was required to repay these disputed expenses and was affirmed by this court in Greynolds Park Manor, Inc. v. HRS, 454 So. 2d 29 (Fla. 1st DCA 1984). After the Section 120.57 hearing, Grey-nolds and HRS proceeded with discovery on the Section 120.56 petition. One week pri- or to the scheduled hearing thereon, HRS filed a motion to dismiss on grounds of mootness. The motion a…
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Greynolds Park Manor, Inc. v. State, 496 So. 2d 164 (Fla. 1st DCA 1986)…nge request. The hearing officer’s recommended order was adopted by the Secretary on August 16, 1983 (“Greynolds I”). The Secretary’s order was affirmed by this court in Greynolds Park Manor, Inc. v. Department of Health and Rehabilitative Services, 454 So. 2d 29 (Fla. 1st DCA 1984). Subsequent thereto, on June 7, 1983, Greynolds renewed its request for an interim rate change for fiscal year 1980. This request was denied on October 12, 1983, on the following ground as stated by HRS in a letter to counsel fo…
Authorities Cited
- Fla. Dep't OF Transp. v. J. W. C. Co., Inc., 396 So. 2d 778 (Fla. 1st DCA 1981)
- Henry v. State, 431 So. 2d 677 (Fla. 1st DCA 1983)