Division of Administrative Hearings, Florida
Filed: Jan. 10, 2014
The primary issue is whether, under section 409.913(16)(j), Florida Statutes, Petitioner can establish and recover from Respondent overpayments for Medicaid claims for community mental health services that Respondent provided to recipients who were enrollees in plans of various managed care organizations (MCOs) that, pursuant to the standard contract between these MCOs and the Department of Elder Affairs (DOEA), provided services under the Nursing Home Diversion Waiver (NHDW) program.1/ A secondary issue is whether Petitioner is liable to Respondent, under sections 57.105(1)(a) and (5), Florida Statutes, for attorneys' fees for presenting a claim for overpayment that Petitioner knew or should have known was not supported by the necessary material facts.Agency must pay Medicaid provider reasonable attorneys' fees incurred in defending a Medicaid overpayment case. Fees claimed by provider's attorneys reduced by nearly $120,000 because fees over $61,505 were unnecessary, excessive, or inappropriate.
