ILNews

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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  1. Call it unauthorized law if you must, a regulatory wrong, but it was fraud and theft well beyond that, a seeming crime! "In three specific cases, the hearing officer found that Westerfield did little to no work for her clients but only issued a partial refund or no refund at all." That is theft by deception, folks. "In its decision to suspend Westerfield, the Supreme Court noted that she already had a long disciplinary history dating back to 1996 and had previously been suspended in 2004 and indefinitely suspended in 2005. She was reinstated in 2009 after finally giving the commission a response to the grievance for which she was suspended in 2004." WOW -- was the Indiana Supreme Court complicit in her fraud? Talk about being on notice of a real bad actor .... "Further, the justices noted that during her testimony, Westerfield was “disingenuous and evasive” about her relationship with Tope and attempted to distance herself from him. They also wrote that other aggravating factors existed in Westerfield’s case, such as her lack of remorse." WOW, and yet she only got 18 months on the bench, and if she shows up and cries for them in a year and a half, and pays money to JLAP for group therapy ... back in to ride roughshod over hapless clients (or are they "marks") once again! Aint Hoosier lawyering a great money making adventure!!! Just live for the bucks, even if filthy lucre, and come out a-ok. ME on the other hand??? Lifetime banishment for blowing the whistle on unconstitutional governance. Yes, had I ripped off clients or had ANY disciplinary history for doing that I would have fared better, most likely, as that it would have revealed me motivated by Mammon and not Faith. Check it out if you doubt my reading of this, compare and contrast the above 18 months with my lifetime banishment from court, see appendix for Bar Examiners report which the ISC adopted without substantive review: https://www.scribd.com/doc/299040839/2016Petitionforcert-to-SCOTUS

  2. Wow, over a quarter million dollars? That is a a lot of commissary money! Over what time frame? Years I would guess. Anyone ever try to blow the whistle? Probably not, since most Hoosiers who take notice of such things realize that Hoosier whistleblowers are almost always pilloried. If someone did blow the whistle, they were likely fired. The persecution of whistleblowers is a sure sign of far too much government corruption. Details of my own personal experience at the top of Hoosier governance available upon request ... maybe a "fake news" media outlet will have the courage to tell the stories of Hoosier whistleblowers that the "real" Hoosier media (cough) will not deign to touch. (They are part of the problem.)

  3. So if I am reading it right, only if and when African American college students agree to receive checks labeling them as "Negroes" do they receive aid from the UNCF or the Quaker's Educational Fund? In other words, to borrow from the Indiana Appellate Court, "the [nonprofit] supposed to be [their] advocate, refers to [students] in a racially offensive manner. While there is no evidence that [the nonprofits] intended harm to [African American students], the harm was nonetheless inflicted. [Black students are] presented to [academia and future employers] in a racially offensive manner. For these reasons, [such] performance [is] deficient and also prejudice[ial]." Maybe even DEPLORABLE???

  4. I'm the poor soul who spent over 10 years in prison with many many other prisoners trying to kill me for being charged with a sex offense THAT I DID NOT COMMIT i was in jail for a battery charge for helping a friend leave a boyfriend who beat her I've been saying for over 28 years that i did not and would never hurt a child like that mine or anybody's child but NOBODY wants to believe that i might not be guilty of this horrible crime or think that when i say that ALL the paperwork concerning my conviction has strangely DISAPPEARED or even when the long beach judge re-sentenced me over 14 months on a already filed plea bargain out of another districts court then had it filed under a fake name so i could not find while trying to fight my conviction on appeal in a nut shell people are ALWAYS quick to believe the worst about some one well I DID NOT HURT ANY CHILD EVER IN MY LIFE AND HAVE SAID THIS FOR ALMOST 30 YEARS please if anybody can me get some kind of justice it would be greatly appreciated respectfully written wrongly accused Brian Valenti

  5. A high ranking Indiana supreme Court operative caught red handed leading a group using the uber offensive N word! She must denounce or be denounced! (Or not since she is an insider ... rules do not apply to them). Evidence here: http://m.indianacompanies.us/friends-educational-fund-for-negroes.364110.company.v2#top_info

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