Medical Malpractice Copays

Mulberry Square Elder Care and Rehabilitation Center v. Department of Human Services, 2018 Pa. Cmwlth. LEXIS 352 (July 26, 2018) Simpson, J. Mulberry Square Elder Care and Rehabilitation Center (Nursing Facility) petitions for review from an order of the Secretary of the Department of Human Services (Department). The Secretary affirmed the Bureau of Hearings and Appeals’ (BHA) order adopting the Administrative Law Judge’s (ALJ) recommendation denying relief and rejecting Nursing Facility’s billing practice. Specifically, the Department disallowed Nursing Facility’s practice of recouping unpaid copayments from residents eligible for medical assistance by billing the Department for the copays as medical expenses. The Department also concluded this practice constituted balance-billing prohibited by applicable law. Nursing Facility argues the Department did not promulgate a regulation explicitly precluding its billing practice. Discerning no error below, we affirm.