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8 N.J.A.R. 217

Medical Assistance and Health Services, Division of; Bridgeton Nursing Center, Inc. and Jack Verschleisser v
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Citation: 8 N.J.A.R. 217
Decision Date: 1983
Agency: DIVISION OF MEDICAL ASSISTANCE
Synopsis: Petitioners sought relief from the claim determination of the Division of Medical Assistance and Health Services for recovery of Medicaid overpayments. The administrative law judge assigned to the case found that no issue of fact existed but that petitioners sought to bar the collection of overpayment on a variety of legal arguments. The judg e rejected petitioners' argument that the Division was precluded from recovering the overpayments based upon equitable estoppel. While acknowl- edging that a considerable period of time elapsed during which the Division failed to indicate that overpayments had been made, the judge determined that the petitioners had failed to show that an officer of the State, conscious of the State's true interest and aware of peti- tioners' misapprehension stood by while the other party acted in detrimental reliance. Accordingly, the judge concluded that recovery of the overpayments with interest was appropriate. In addition, the judge determined that the Division might pierce the corporate veil to hold a major shareholder of a nursing home corporation, who is also the principal operating officer, liable for Medicaid overpayments when the failure to do so would permit the circumvention of the statutory and legislative scheme in recouping such overpayments. Upon review, the Director of the Division of Medical Assistance and Health Services adopted this initial decision. Leonard M. Fishman, Esq., and Murray J. Klein, Esq., for petitioner (Tomar, Gelade, Kamensky, Klein, Smith and Lehmann, attorneys) Ivan J. Punchatz, Deputy Attorney General, for respondent (Irwin I. Kimmelman, Attorney General of New Jersey, attorney) Initial Decision
Rule(s) Cited: 10:49-1.27