Summary
The Nebraska Supreme Court affirmed the district court’s order upholding the Nebraska Department of Health and Human Services’ permanent exclusion of Ann Tran from the Medicaid program. The court concluded that competent evidence supported findings that Tran submitted overlapping service billings and failed to maintain required records. It also held that the sanction was not arbitrary, capricious, or unreasonable.
Topics
Practice areas
Questions Presented
- Whether competent evidence supported the district court's finding that Tran billed for overlapping Medicaid services.
- Whether permanent exclusion from the Medicaid program was an arbitrary, capricious, unreasonable, or otherwise excessive sanction.
Holdings
- The district court's finding that Tran submitted bills for overlapping services between Medicaid clients was supported by competent evidence.
- DHHS may sanction a Medicaid service provider for presenting false claims, failing to produce required service records, or breaching the Medicaid provider agreement.
- Permanent exclusion from the Medicaid program was within DHHS's sanctioning authority and was not arbitrary, capricious, or unreasonable on this record.
- Although the district court reviews the agency decision de novo and may modify the agency's sanction, the Nebraska Supreme Court reviews the district court's APA judgment only for errors appearing on the record.
Key quotations
“However, our review is limited to reviewing an order of a district court under the APA for errors appearing on the record; the inquiry is whether the decision conforms to the law, is supported by competent evidence, and is neither arbitrary, capricious, nor unreasonable; and we will not substitute our factual findings for those of the district court where competent evidence supports those findings.” (303 Neb. at 13)
Factual background
Tran provided personal assistance services to Nebraska Medicaid clients and submitted claims supported by timesheets. DHHS found that she billed overlapping services between Medicaid clients and failed to maintain and produce required service records. Tran admitted that she completed timesheets in advance, did not correct them after providing services, and received nearly $880 in overpayments. DHHS terminated her provider agreements and permanently excluded her from the Medicaid program.
Procedural history
DHHS suspended Tran's Medicaid payments while investigating overlapping claims and recordkeeping. DHHS terminated her provider agreements and permanently excluded her from the Medicaid program. After an administrative hearing, the DHHS director affirmed the action. The Lancaster County District Court affirmed DHHS, and the Nebraska Supreme Court affirmed the district court.