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ALJ Reverses Excessive Penalty
In the Administrative Action entitled In the Matter of Assure Health Care Providers Assure, a Home and Community Based Service (HBCS) provider, sought administrative review by an Administrative Law Judge (ALJ) of the decision of the Louisiana Department of Health to impose a monetary penalty of $317, 868.27 for an eight month lapse of worker’s compensation coverage. Assure argued that the penalty was excessive and that the maximum penalty the Department could impose was $10,000.00. The Department countered with the argument that the amount imposed was not a penalty but instead a recoupment. In sur-reply Assure argued that as the Department was not challenging the quality or delivery of its services a recoupment by the Department for all sums paid to Assure during the period of Worker’s Compensation lapse would result in unjust enrichment to the Department.
In agreeing with Assure and reversing the Department’s decision, the ALJ on May 5, 2020 aptly observed:
Based upon the preponderance of the evidence, Assure’s lack of worker’s compensation insurance from September 20, 2016 to May 2, 2017, was a single violation which included multiple occurrences. Because Assure had a single violation of lapsed worker’s compensation insurance that was found through an individual audit, the monetary penalty allowed under Medicaid policy is $10,000.00. The monetary penalty of $317,868.27 exceeds the allowed monetary penalty limit of $10,000.00. The Department’s monetary penalty of $317,868.27 violates the Department’s own rule, and as such, the imposed monetary penalty is incorrect.
The ALJ's decision was approved and certified as the final decision of the Louisiana Department of Health by the Department's Undersecretary on August 12, 2020. On August 25, 2020 the Department sought reconsideration of the ALJ's Decision. On September 11, 2020 the Department's Petition for Reconsideration was denied by the ALJ.
Assure was represented in this matter by Aaron & Gianna attorneys William D. Aaron, Jr. and Courtney Payton .
