Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-71 - Hearings for recovery of overpayments
Section 5160-71-07 - Chapter 119. hearings conducted under authority of section 5111.914 of the Revised Code: conduct of the hearing and adjudication order
Universal Citation: OH Admin Code 5160-71-07
Current through all regulations passed and filed through September 16, 2024
(A) Conduct of the hearing.
(1) The issuing state agency shall
employ or contract with a hearing examiner to conduct all hearings initiated
under authority of section
5111.914 of the Revised Code.
(2) The date, time, and place of
any hearing under authority of section
5111.914 of the Revised Code is
set by the issuing state agency or the hearing examiner. The hearing examiner
shall provide written or electronic notice before the date of the hearing to
all participants in the hearing and file a copy of the written notice in the
record of the hearing.
(3) Subject
to the prior approval of the hearing examiner, any appellant may choose to
present the case entirely in writing provided that a written request is made by
the appellant no later than fourteen business days before the date scheduled
for the hearing. Any request to present the case entirely in writing must be
filed with the hearing examiner. Any appellant who elects to present the case
entirely in writing must do so in accordance with procedures ordered by the
hearing examiner. The hearing examiner's order must be in writing and filed in
the record of the hearing. In the event that the appellant elects to present
its case in writing, the issuing state agency may elect to present its case
entirely in writing. Nothing in this rule is to be construed as preventing the
issuing state agency from compelling the attendance of the appellant or other
witnesses at the hearing and questioning the appellant or other witnesses as if
on cross-examination. Nothing in this rule is to be construed as preventing any
appellant from examining any witnesses or evidence presented by the issuing
state agency at the hearing.
(4)
During the course of any hearing, the participants to the proceeding may enter
into oral stipulations of fact, procedure, or the authenticity of documents
that will be incorporated into the record and will bind the conduct of the
participants. The hearing examiner conducting the case may require oral
stipulations to be reduced to writing and submitted to the hearing examiner.
The hearing examiner assigned to conduct a hearing has the power to rule on the
admissibility of evidence or testimony, but a participant may make objections
to the rulings thereon. If the hearing examiner refuses to admit evidence or
testimony, the participant seeking admission of same must make a proffer
thereof and such proffer will be made a part of the record of the hearing. The
hearing examiner may refer to the guidelines contained in the Ohio Rules of
Evidence (7/1/2007) in making decisions on admissibility.
(B) Findings of fact, conclusions, recommendations, and objections.
(1) Upon the
conclusion of any hearing, the hearing examiner shall prepare a
written report of findings of fact, conclusions of law, and recommendations of
departmental action to be taken in disposition of the
case.
The hearing examiner shall file the report, together with a complete record of
the proceeding, with the issuing state agency within not more than forty-five
days after the conclusion of the hearing, unless the parties agree to an
extension of the time for the filing of the hearing examiner's report. Within
five days of its completion, the issuing state agency
shall
send by certified mail, return receipt requested, to the appellant or the
appellant's attorney, a copy of the hearing examiner's report. The report will
be considered to have been mailed as of the date appearing on U.S. postal
service form 3800 or any future equivalent postal
service form. Also, on completion of the report and recommendation, the
issuing state agency shall submit its hearing officer's report and
recommendation and the complete record of proceedings, including all
transcripts, to ODJFS for final adjudication.
(2) An appellant may file written objections
to the hearing examiner's report with ODJFS. Any
such objections must be received by ODJFS no later than ten days after the
appellant receives the report. Any such objections must be filed with the
depository agent
of ODJFS. ODJFS may grant an extension of time to
file objections if the appellant's written request for an extension is received
by ODJFS no later than ten days after the appellant's receipt of the report.
The date the appellant receives the hearing examiner's report is the date
indicated on the U.S. postal service form 3800 or any
future equivalent postal service form. The director will consider timely
written objections before approving, modifying, or disapproving the
recommendations of the hearing examiner.
(C) Final order of adjudication.
(1) Recommendations of the hearing examiner
may be approved, modified, or disapproved by the director. The director may
remand the
matter back to the issuing state agency to allow for additional testimony
to be taken and permit the introduction of further documentary evidence. In
those instances where the director modifies or disapproves the recommendations
of the hearing examiner, the director will include the reasons therefore and
incorporate them into the final order of adjudication.
(2) After the director has entered an order
approving, modifying, or disapproving the hearing examiner's recommendation on
the ODJFS journal of proceedings, the director will mail to the appellant and
any attorney of record by certified mail, return receipt requested, a copy of
the order and a statement of the time and method by which an appeal may be
perfected. The director shall provide a copy of the order to the issuing state
agency.
(D) Appeal of final adjudication order.
(1) Any appellant
against whom a final order of adjudication is entered, pursuant to this rule,
may appeal that order to the Franklin county court of common pleas.
(2) Any appellant desiring an appeal pursuant
to this rule must file a notice of appeal with the depository agent of ODJFS
and with the issuing state agency, setting forth the order appealed from and
stating that the agency's order is not supported by reliable, probative, and
substantial evidence and is not in accordance with the law. The notice may, but
need not, set forth the specific grounds of the party's appeal beyond the
statement that the agency's order is not supported by reliable, probative, and
substantial evidence and is not in accordance with the law. In order to be
determined filed with ODJFS, the notice of appeal must be received by ODJFS, as
evidenced by an ODJFS date and time stamp, no later than fifteen days after the
mailing to the affected party, as evidenced by U.S. postal service form 3800,
or any future equivalent postal form, of the order to be appealed from.
Appellant shall also file the notice of appeal with the court of common pleas
no later than fifteen days after the mailing to the affected party, as
evidenced by U.S. postal service form 3800, or any future equivalent postal
form, of the order to be appealed from. In filing a notice of appeal with
ODJFS, the issuing state agency or court, the notice that is filed may be
either the original or a copy of the original notice.
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