Colwell v. Iowa Department of Human Services

The Supreme Court affirmed in part and reversed and remanded in part the judgment of the district court in this challenge to the decision of the Iowa Department of Human Services (DHS) denying a dentist’s requests for a state fair hearing, holding, among other things, that the district court erred in finding that Iowa Code 249A.4(11) requires DHS to afford the dentist a state fair hearing but correctly found that the administrative rules require DHS to give the dentist a state fair hearing.After a managed care organization (MCO) denied reimbursement of claims submitted by Plaintiff, a dentist who contracted with the MCO as a provider, Plaintiff sought review. DHS concluded that the issue of the MCO’s denials of reimbursement was not appealable to DHS. The district court concluded that Plaintiff was entitled to a state fair hearing and that Plaintiff could seek reimbursement from his indigent patients for claims not covered or reimbursed by the MCO. The Supreme Court remanded the case, holding (1) Plaintiff was entitled to a state fair hearing; (2) Plaintiff may bill patents for services not covered or reimbursed by the MCO, but only to the extent as set forth in this opinion; and (3) the district court erred in awarding Plaintiff attorney fees. View "Colwell v. Iowa Department of Human Services" on Justia Law