Fair Hearing of the Month
Fair Hearing #5056260H (04-23-2009)

August 3, 2010

Congratulations to Robin Marable, Esq., Monroe County Legal Assistance Corporation

Appellant had been restricted to a single pharmacy and a single provider due to alleged abuses of Medicaid benefits. During the hearing the Agency showed that the Appellant had submitted 10 different claims to Medicaid that had been denied by 6 different health care providers. The ALJ held that the burden of proof was on the Agency to establish abuse such as duplicate prescriptions or unnecessary emergency room use. Since the Agency was not able to provide any evidence of why the claims had been denied or any causal relationship between these denials and improper use, the Agency was directed to cease the restriction on the Appellant's Medical Assistance.

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