In the Matter of the Sirs Appeal by Best Care, LLC

Summary

The court held that DHS cannot obtain monetary recovery merely by proving that a vendor engaged in sanctionable conduct or that an error occurred. DHS must also prove that the conduct caused an improper payment under an independent statute or valid regulation, or that an error caused the vendor to receive more than legally authorized. The court also held that PCA provider agencies must keep care plans for PCA Choice recipients in both the recipient’s home and the agency’s file, and remanded for application of the proper monetary-recovery standard.