Partial federal government shutdown
HCA does not anticipate any immediate impacts to our services or disruption to provider payments at this time. We will continue to monitor the situation and share updates if anything changes.
HCA does not anticipate any immediate impacts to our services or disruption to provider payments at this time. We will continue to monitor the situation and share updates if anything changes.
Effective March 16, 2017
This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.
Review each hearing request on an overpayment, to determine if equitable estoppel is a factor. If yes, apply the following guidelines to determine if the case is appropriate for use of the stipulation and agreed order.
Guidelines for Establishment of Equitable Estoppel:
Element #1:
An admission, statement, or act by the agency, which is inconsistent with a later claim. The agency made a statement, took action, or failed to act and later found that it was incorrect. The individual is informed after the fact that the error was made.
Factors which may be used as evidence of element #1:
Element #2:
An action by the individual on the faith of the agency's admission, statement, or act. The individual must have taken some action that was reasonable given the circumstances (i.e., utilized the COPES services).
Factors which may be used as evidence of element #2:
Element #3:
An injury to the individual arising from permitting the agency to contradict or repudiate such admission, statement, or act. The individual experiences either a loss or a detrimental change in their position because the agency reverses a decision regarding eligibility. Depending on the specific circumstances of the case, the imposition of a debt that could not be anticipated or avoided by the individual may establish injury.
Factors which may be used as evidence of injury:
Element #4:
Equitable estoppel is necessary to prevent a manifest injustice. The overpayment is clearly unfair to the individual based on the way that it occurred and repayment would compromise the individual's ability to meet basic needs.
Factors which can be used as evidence of element #4:
Element #5:
Applying equitable estoppel will not impair the exercise of governmental powers. Element #5 will be considered to be met unless there is an extraordinary circumstance. This element must be considered on a case-by-case basis. The cumulative effect of equitable estoppel applied to many cases is not permitted.