Mocznianski v. Ohio Dept. of Medicaid

2020 Ohio 165
CourtOhio Court of Appeals
DecidedJanuary 21, 2020
Docket18AP-894
StatusPublished
Cited by3 cases

This text of 2020 Ohio 165 (Mocznianski v. Ohio Dept. of Medicaid) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mocznianski v. Ohio Dept. of Medicaid, 2020 Ohio 165 (Ohio Ct. App. 2020).

Opinion

[Cite as Mocznianski v. Ohio Dept. of Medicaid, 2020-Ohio-165.]

IN THE COURT OF APPEALS OF OHIO

TENTH APPELLATE DISTRICT

Terrence L. Mocznianski, :

Appellant-Appellant, : No. 18AP-894 v. : (C.P.C. No. 18CV-4855)

Ohio Department of Medicaid, : (REGULAR CALENDAR)

Appellee-Appellee. :

D E C I S I O N

Rendered on January 21, 2020

On brief: The DuBose Law Firm, LLC, and Shakeba DuBose, for appellant. Argued: Shakeba DuBose.

On brief: Dave Yost, Attorney General, Stephanie Deters, and Roger Carroll, for appellee. Argued: Stephanie Deters.

APPEAL from the Franklin County Court of Common Pleas

DORRIAN, J. {¶ 1} Appellant, Terrence L. Mocznianski, appeals the October 31, 2018 decision and entry of the Franklin County Court of Common Pleas, which affirmed the May 24, 2018 final adjudication order issued by appellee, Ohio Department of Medicaid ("ODM"). For the following reasons, we affirm. I. Facts and Procedural History {¶ 2} This matter arises out of a determination that appellant had been overpaid for services he provided as caregiver to his disabled sibling. On February 22, 2017, the Ohio Department of Developmental Disabilities ("ODDD") sent appellant, by certified mail, a notice of overpayment and request for voluntary repayment. In the notice, ODDD advised appellant it had completed a Home and Community-Based Services Medicaid waiver No. 18AP-894 2

review ("waiver review") of his services for the period from July 1, 2011 through June 30, 2014. Pursuant to R.C. 5164.58(B)(1) and Ohio Adm.Code 5160-71-02(A), ODDD requested appellant make a voluntary repayment in the amount of $94,293.76, in addition to accrued interest in the amount of $9,377.71 and daily interest in the amount of $9.69 from the date of the notice until receipt of payment. On March 20, 2017, appellant sent a letter to ODDD disputing the alleged overpayment. {¶ 3} On April 26, 2017, ODDD sent appellant notice of intended action and opportunity for hearing. In the notice, ODDD stated that, because it had been unable to secure voluntary repayment or enter into a negotiated settlement, it was proposing the director of ODM issue an adjudication order finding appellant received an overpayment. On May 22, 2017, appellant sent a letter disputing the proposed adjudication order and requesting a hearing pursuant to R.C. Chapter 119. {¶ 4} On March 6, 2018, an ODDD hearing examiner held a hearing on the matter. At the hearing, Halina Schroeder, audit chief of ODDD, testified she supervised the ODDD employees who conducted the Medicaid waiver review of appellant's services. Schroeder explained that Medicaid waiver reviews are reviews of claims billed by and paid to Medicaid providers for services to individuals with developmental disabilities. In the review, ODDD employees ensure providers have submitted service documentation validating the nature and extent of services provided in compliance with the requirements in the Ohio Administrative Code. {¶ 5} Schroeder testified that auditors utilize a risk-based approach when selecting providers for review. Appellant was selected under this approach because he was a highly paid provider who was providing a significant number of hours consistently throughout the waiver review period, which encompassed July 1, 2011 through June 30, 2014. Auditors conducted the review on the first month of each quarter of the review period. Schroeder testified that appellant, during the review period, provided "homemaker/personal care" to his sibling, who lived with him. During the review period, appellant received a total of $283,270.00 for 69,600 units of service, each of which comprised a 15-minute billing period. {¶ 6} According to Schroeder, an ODDD auditor, on September 16, 2016, sent appellant a waiver review notification letter informing him that he had been selected for a No. 18AP-894 3

waiver review. The ODDD auditor requested from appellant service documentation corresponding to the waiver review time period. The ODDD auditor also requested from the Lucas County Board of Developmental Disabilities ("LCBDD"), the county-level agency responsible for providing training to providers and completing review processes on behalf of ODDD, documentation for the relevant time period. Thereafter, another ODDD auditor reviewed the documentation and made findings that were incorporated into a report. {¶ 7} According to Schroeder, on February 22, 2017, ODDD sent by certified mail a notice, which was admitted into the record, to appellant of the completion of the waiver review report. ODDD attached to the notice the waiver review report in addition to relevant statutory and administrative code provisions. ODDD also attached to the notice an invoice and a request for voluntary repayment of the overpayment. {¶ 8} Schroeder testified that, ODDD, in the waiver review report, found there were 23,168 units of provided service that were undocumented or unsupported in violation of the applicable provisions of the Ohio Administrative Code, resulting in an overpayment amount of $94,293.76, plus interest. In the waiver review report, ODDD specifically found that the service documentation lacked the following: (1) "Number of Units of Delivered Service (APC)"; (2) "Arrival and Departure Times (APC, through 4/18/12)"; and (3) "Begin and End Times of Delivered Service (APC, effective 4/19/12)." (ODDD Hearing, State's Ex. 15 at 14.)1 {¶ 9} Schroeder testified that without the inclusion of the number of units on the service documentation "it's difficult to determine whether or not the correct number of units was billed and/or determine how many units of service were actually provided." (Mar. 6, 2017 Tr. at 22.) Schroeder further testified that appellant was not authorized to provide 24-hour service, because the "individual service plan specifically stated that natural supports were also to be provided to the individual, and 'natural supports' is when family or friends provide * * * care for the individual as a normal course of [the] family unit." (Mar. 6, 2017 Tr. at 31-32.) Schroeder stated that natural supports were not eligible for payment.

1We note that the February 22, 2017 notice identified "APC" as the "service code" for "Homemaker Personal Care." (State's Ex. 15 at 1.) No. 18AP-894 4

{¶ 10} Schroeder testified that after the waiver review report was sent to appellant, ODDD provided appellant with an opportunity to submit additional documentation. Appellant did not submit any additional service documentation but, instead, provided documentation that he claimed showed the LCBDD had informed him that his documentation was acceptable. However, the documentation provided by appellant did not alter the findings because it was either outside the applicable review period or did not relate to the missing information from appellant's service documentation. {¶ 11} According to Schroeder, LCBDD was responsible for completing compliance reviews for ODDD's Office of Provider Standards and Review. Schroeder stated that compliance reviews did not serve the same purpose as the audits performed for waiver reviews because LCBDD did not review "the documentation to any claims paid or any billing submitted by the providers." (Mar. 6, 2017 Tr. at 38.) Furthermore, unlike waiver reviews, the compliance reviews did not involve the issuance of recoverable findings and typically only covered a three-month period of the provider's documentation. As a result, the compliance reviews were not determinative of the findings made under a waiver review.

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2020 Ohio 165, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mocznianski-v-ohio-dept-of-medicaid-ohioctapp-2020.