4.4 Overpayments

DHA Case No. MAC 206795 (Wis. Div. of Hearings and Appeals February 8, 2023) (DHS) ↓ Download PDF To prevail at an appeal regarding an Order to Compel Payment of MA/BCP Liability, the agency must show, to begin with, that it provided proper notice of the underlying overpayment. Proper notice must include both the right […] Read more

DHA Case No. MOP 197486 (Wis. Div. of Hearings and Appeals February 27, 2020) (DHS) ↓ Download PDF To establish an overpayment, the Department has the burden of proof by the preponderance of the evidence. In this case, the issue was whether the petitioner’s husband lived with her or not (if so, her household income […] Read more

DHA Case No. MOP 200346 (Wis. Div. of Hearings and Appeals February 10, 2021) (DHS) ↓ Download PDF In an overpayment hearing, the agency has the burden to prove, by the preponderance of the evidence, both that the petitioner failed to provide accurate or complete information and that the petitioner was not eligible during the […] Read more

DHA Case No. MOP 204371 (Wis. Div. of Hearings and Appeals May 2, 2022) (DHS) ↓ Download PDF A person must be a resident of Wisconsin to receive Medicaid benefits, and residency ends if another state determines the person to be a resident for its own Medicaid programs. In this case, the petitioner applied for […] Read more

DHA Case No. MED 67/53178 (Wis. Div. Hearings and Appeals Feb. 28, 2003) (DHS)  ↓ Download PDF In this case, a Medicaid recipient failed to report a divestment that occurred after her initial application was approved and benefits had started. The ALJ held that, despite the failure to report, the overpayment of benefits was not […] Read more