November 23, 2015
The purpose of this memorandum is to serve as a reminder to all Medicaid providers regarding the ruling 1 by the Court of Appeals in 1st Stop Health Services v. DMAS in April 2014. The Court held that supplemental documentation and testimony offered by the provider did not cure the provider’s failure to provide adequate documentation to auditors at the time of the audit. The Court’s decision emphasized the requirement for providers to maintain contemporaneous documentation of services provided as specified in the Provider Agreement, which incorporates by reference the applicable laws, regulations and policy manuals. The Court also reaffirmed the policy that all provider documentation required to support claims for reimbursement must be maintained prior to and submitted by the provider at the time of the audit.
The Court’s decision is binding precedent on the Department and its providers. During the audit and appeal processes, DMAS shall only consider documentation submitted by the provider during the course of the audit and prior to the deadline stated in the preliminary findings letter.