X

Thank you for sharing!

Your article was successfully shared with the contacts you provided.

This Medicaid reimbursement case is before us for a second time. The appeal began when the Georgia Department of Community Health challenged a superior court ruling that reversed the department’s calculation of Medicaid reimbursement rates for a nursing facility owned by Pruitt Corporation.1 We reversed the superior court’s judgment on appeal, but the Supreme Court found fault with our standard of review and remanded the case to us for further consideration.2 We have now conducted the appropriate review, and we affirm the superior court ruling. Although our prior opinion sets forth the facts in detail, we will repeat the relevant facts here for ease of discussion. In order to participate in the state Medicaid program, a nursing facility must enter into an agreement with the department. That agreement incorporates by reference the department’s nursing facility policies and procedures manual, which sets forth the methodology for calculating Medicaid reimbursement rates.

Pursuant to the manual, the department establishes a facility-specific “per diem” Medicaid reimbursement rate for each nursing facility based on revenues, expenses, and statistical data reflected in a facility’s “cost report.” Nursing facilities must submit an annual cost report by September 30 for each fiscal year ending June 30. The department then audits the report and establishes a new per diem rate for the facility for the following fiscal year. When a nursing facility changes ownership, the department requires both the buyer and seller to submit a cost report for the respective period of time that it operated the facility.

 
Reprints & Licensing
Mentioned in a Law.com story?

License our industry-leading legal content to extend your thought leadership and build your brand.

More From ALM

With this subscription you will receive unlimited access to high quality, online, on-demand premium content from well-respected faculty in the legal industry. This is perfect for attorneys licensed in multiple jurisdictions or for attorneys that have fulfilled their CLE requirement but need to access resourceful information for their practice areas.
View Now
Our Team Account subscription service is for legal teams of four or more attorneys. Each attorney is granted unlimited access to high quality, on-demand premium content from well-respected faculty in the legal industry along with administrative access to easily manage CLE for the entire team.
View Now
Gain access to some of the most knowledgeable and experienced attorneys with our 2 bundle options! Our Compliance bundles are curated by CLE Counselors and include current legal topics and challenges within the industry. Our second option allows you to build your bundle and strategically select the content that pertains to your needs. Both options are priced the same.
View Now
May 01, 2025
Atlanta, GA

The Daily Report is honoring those attorneys and judges who have made a remarkable difference in the legal profession.


Learn More
December 11, 2024
Las Vegas, NV

This event shines a spotlight on how individuals and firms are changing the investment advisory industry where it matters most.


Learn More
February 24, 2025 - February 26, 2025
Las Vegas, NV

This conference aims to help insurers and litigators better manage complex claims and litigation.


Learn More

McCarter & English, LLP is actively seeking a litigation associate for its office located in Hartford, CT. One to three years of experie...


Apply Now ›

Borteck & Czapek, P.C., based in Florham Park, is a boutique estates and trusts law firm specializing in estate planning and administrat...


Apply Now ›

Gwinnett County State Court is seeking an attorney to assist the Judge by conducting a variety of legal research, analysis, and document pre...


Apply Now ›