Seasons of Hope Requests Admin. Hearing in Appeal

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Updated: 4/26/2013 11:59 am

The 40-page appeal filed by Seasons of Hope following allegations of medicaid fraud has been released to the public.

As part of the appeal, Seasons of Hope says a five-day administrative hearing may be necessary to review the hundreds of documents entered as evidence on both sides of the case.

Seasons of Hope contends in the appeal that the amount of recoupment claimed by IDHW is vague and ambiguous and doesn't give the clinic a chance to offset that amount with any money owed to Seasons for services provided that have not been reimbursed.

Seasons of Hope also argues that IDHW claims they have a credible allegation of fraud but does not identify where that allegation stems from in the agency letter which was sent to Seasons.  "The Department fails to plead fraud with particularity and sufficient detail and fails to make out the elements of fraud on its face," according to the appeal.

Seasons also disputes IDHW's claim that they had no other choice but to suspend all Medicaid payments.  Instead the clinic feels like the state agency wanted to take that extreme action.

The entire appeal has been attached to this story for further reading.

PREVIOUS STORY: An Eastern Idaho mental health clinic that was suspended from getting Medicaid payments in March has filed an appeal contesting the state Department of Health and Welfare's decision.

Chubbuck-based Seasons of Hope clinic submitted its appeal late Wednesday night.

The state says the company revoked the company's provider status following an 18-month investigation that found it billed for services that weren't covered, misrepresented services and billed for services not documented.

But details on the clinic's defense are still unclear.

Health and Welfare spokesman Tom Shanahan said the department can't yet release the more than 40-page appeal document because it includes patient names and information. He said details will be provided after the state redacts sensitive material.

A date for an administrative hearing will be set within the next 30 days unless the company requests more time.

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