In the Matter of the SIRS Appeal by Best Care, LLC

Syllabus

1. To obtain monetary recovery under Minnesota Statutes section 256B.064, subdivision 1c(a) (2022), the Minnesota Department of Human Services (DHS) must prove either (1) that a vendor engaged in conduct identified in Minnesota Statutes section 256B.064, subdivision 1a (2024), and that, had DHS known of the conduct before payment, it would have been legally prohibited from making payment based on a statute or valid regulation independent of section 256B.064, subdivision 1a; or (2) that the 1 payment resulted from an error, intentional or not, by DHS or the individual or entity submitting the claim such that the vendor received more money than authorized by law. 2. Care plans must be maintained in the provider agency file for all Personal Care Assistant (PCA) services, including for PCA Choice recipients, under Minnesota Statutes section 256B.0659, subdivision 7(a) (2024). Affirmed in part, reversed in part, and remanded.