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Judges send Medicaid case back for review

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The Indiana Court of Appeals remanded a Medicaid benefits denial to the Administrative Law Judge because her decision lacked findings of fact making the case mostly unreviewable by the appellate court.

Alesa Pack applied for Medicaid in 2008. Prior to her application, she had been in two car accidents, diagnosed with panic disorder and schizophrenia, and had many surgeries and treatments for her injuries from the accidents. Pack mentioned physical and psychological ailments as her reason for applying. The review team, ALJ, and Family and Social Services Administration denied benefits; the trial court ruled against Pack.

While her appeal was pending, Pack obtained Medicaid benefits, but this issue isn’t moot because the application for benefits at issue covers medical costs from a two-year period during which her newly awarded benefits don’t provide coverage, noted Judge L. Mark Bailey.

In reviewing the ALJ’s decision, the appellate court found no error in her decision regarding Pack’s physical condition. The ALJ found basic facts contrary to Pack’s assertions and concluded through a proper application of the regulations that she wasn’t substantially impaired from walking or light office work. But the ALJ barely touched upon Pack’s psychiatric conditions. The ALJ didn’t apply the functional limitation factors set forth in the state’s Medicaid regulations and her use of the record on Pack’s psychiatric conditions was selective, wrote Judge Bailey in Alesa Pack v. Indiana Family and Social Services Administration, No. 89A05-1004-PL-240.

“We are mindful here of our duty not to reweigh evidence, a function properly assigned to the ALJ,” he wrote. “Yet the ALJ’s findings here leave us without confidence that she weighed Packs’ psychiatric evidence or applied relevant law to that evidence in reaching a decision.”

The judges sent the case back to the ALJ because the decision was issued “without observance of procedure required by law.” The court also addressed the purposes, function, and proper form of findings of fact and conclusions of law in an administrative context because of the number of administrative orders issued each year.

“Yet we are at times confronted with orders that are defective because the agency’s decision lacks support in the record, that do not adequately articulate a basis for the agency’s decision, that recite the contents of evidence presented to an agency without making proper findings of basic fact, or that simply fail to adequately or rationally apply law to found facts,” Judge Bailey wrote. “Failing to follow proper procedures and form for agency orders may reflect an underlying failure to observe due process of law, whether or not due process was actually had by any or all affected parties and whether or not the agency’s ultimate decision is correct.”

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  4. Mr. Levin says that the BMV engaged in misconduct--that the BMV (or, rather, someone in the BMV) knew Indiana motorists were being overcharged fees but did nothing to correct the situation. Such misconduct, whether engaged in by one individual or by a group, is called theft (defined as knowingly or intentionally exerting unauthorized control over the property of another person with the intent to deprive the other person of the property's value or use). Theft is a crime in Indiana (as it still is in most of the civilized world). One wonders, then, why there have been no criminal prosecutions of BMV officials for this theft? Government misconduct doesn't occur in a vacuum. An individual who works for or oversees a government agency is responsible for the misconduct. In this instance, somebody (or somebodies) with the BMV, at some time, knew Indiana motorists were being overcharged. What's more, this person (or these people), even after having the error of their ways pointed out to them, did nothing to fix the problem. Instead, the overcharges continued. Thus, the taxpayers of Indiana are also on the hook for the millions of dollars in attorneys fees (for both sides; the BMV didn't see fit to avail itself of the services of a lawyer employed by the state government) that had to be spent in order to finally convince the BMV that stealing money from Indiana motorists was a bad thing. Given that the BMV official(s) responsible for this crime continued their misconduct, covered it up, and never did anything until the agency reached an agreeable settlement, it seems the statute of limitations for prosecuting these folks has not yet run. I hope our Attorney General is paying attention to this fiasco and is seriously considering prosecution. Indiana, the state that works . . . for thieves.

  5. I'm glad that attorney Carl Hayes, who represented the BMV in this case, is able to say that his client "is pleased to have resolved the issue". Everyone makes mistakes, even bureaucratic behemoths like Indiana's BMV. So to some extent we need to be forgiving of such mistakes. But when those mistakes are going to cost Indiana taxpayers millions of dollars to rectify (because neither plaintiff's counsel nor Mr. Hayes gave freely of their services, and the BMV, being a state-funded agency, relies on taxpayer dollars to pay these attorneys their fees), the agency doesn't have a right to feel "pleased to have resolved the issue". One is left wondering why the BMV feels so pleased with this resolution? The magnitude of the agency's overcharges might suggest to some that, perhaps, these errors were more than mere oversight. Could this be why the agency is so "pleased" with this resolution? Will Indiana motorists ever be assured that the culture of incompetence (if not worse) that the BMV seems to have fostered is no longer the status quo? Or will even more "overcharges" and lawsuits result? It's fairly obvious who is really "pleased to have resolved the issue", and it's not Indiana's taxpayers who are on the hook for the legal fees generated in these cases.

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