Cabinet for Health and Family Services Department of Medicaid Services v. Appalachian Hospice Care, Inc.

Court of Appeals of Kentucky·Decided February 4, 2021·No. 2020 CA 000684·Unknown

Opinion

RENDERED: FEBRUARY 5, 2021; 10:00 A.M.

NOT TO BE PUBLISHED

Commonwealth of Kentucky

Court of Appeals

NO. 2020-CA-0684-MR

CABINET FOR HEALTH AND FAMILY SERVICES, DEPARTMENT FOR MEDICAID SERVICES; SECRETARY ERIC FRIEDLANDER, IN HIS OFFICIAL CAPACITY AS THE ACTING SECRETARY OF THE CABINET FOR HEALTH AND FAMILY SERVICES; COMMISSIONER LISA LEE, IN HER OFFICIAL CAPACITY AS COMMISSIONER OF THE DEPARTMENT FOR MEDICAID SERVICES APPELLANTS

APPEAL FROM FRANKLIN CIRCUIT COURT v. HONORABLE PHILLIP J. SHEPHERD, JUDGE ACTION NO. 19-CI-01082

APPALACHIAN HOSPICE CARE, INC. APPELLEE

OPINION

AFFIRMING

** ** ** ** **

BEFORE: ACREE, MCNEILL AND L. THOMPSON, JUDGES. L. THOMPSON, JUDGE: The Cabinet for Health and Family Services, Department for Medicaid Services; Secretary Eric Friedlander, in his official

capacity as the acting Secretary of the Cabinet for Health and Family Services; and Commissioner Lisa Lee, in her official capacity as Commissioner of the Department for Medicaid Services appeal from an order of the Franklin Circuit Court which reversed a final order of the Secretary dismissing an administrative action against Appalachian Hospice Care, Inc. We find no error and affirm.

FACTS AND PROCEDURAL HISTORY The Cabinet is charged with administering Kentucky’s Medicaid program and is responsible for recouping Medicaid overpayments made to providers of Medicaid services. A post payment review was conducted by the Cabinet in regard to Medicaid hospice payments made to Appellee during the period of April 1, 2010, through December 31, 2014. In a letter dated June 7, 2018, Appellee was notified of the results of the review. The letter alleged an overpayment of $176,807.14.

Appellee then submitted additional documents to the Cabinet, and another review was performed. The Cabinet issued another letter dated March 13, 2018, notifying Appellee that the overpayment amount had been reduced to $106,985.82. That letter stated:

In accordance with 907 KAR[1] 1:671, sections 8 & 9, you may request an Administrative Hearing and are required to do so in writing. This request should be sent to the Commissioner of DMS, as well as, a copy to the

1 Kentucky Administrative Regulations.

Department for Medicaid Services, Division of Program Integrity, and must be received by DMS within 30 days of receipt of this letter.

The letter then listed the mailing addresses for the Commissioner of the Department for Medicaid Services and the Division of Program Integrity.

In a letter dated April 12, 2018, Sharon Branham, Chief Operating Officer of Appellee, requested a hearing. The letter, properly sent to the relevant recipients, was two sentences long and stated: “In response to the letter the above agency received in response to the final audit report from AdvanceMed.[2] In accordance with 907 KAR 1:671, sections 8 & 9 this agency respectfully request [sic] an Administrative Hearing.”

On May 16, 2018, an order was entered by a Cabinet hearing officer which indicated the Cabinet received the hearing request and a prehearing conference was scheduled. This order also stated:

The law requires a corporation to be represented by an attorney in an administrative proceeding. As [Appalachian Hospice Care, Inc.] is incorporated, Appalachian Hospice Care, Inc., must be represented by an attorney in this matter. Functions customarily performed by an attorney, such as preparing and filing pleadings or other documents, cross-examining witnesses, objecting to testimony, and otherwise representing the interests of an entity, if performed in an administrative proceeding by an individual who is not an attorney, constitutes the unauthorized practice of law.

Kentucky Bar Association v. Henry Vogt Machine Co.,

2 AdvanceMed was the outside contractor tasked with conducting the post payment review.

Inc., Ky., 416 S.W.2d 727 (1967). . . . Appalachian Hospice Care, Inc., shall have an attorney file an Entry of Appearance on its behalf[.]

(Emphasis original.)

Appellee retained counsel and participated in the prehearing conference which occurred on August 1, 2018. Everything proceeded normally, and on October 30, 2018, an administrative hearing was scheduled for February 25-27, 2019. On January 15, 2019, the Cabinet filed a motion to dismiss. The Cabinet claimed that a non-lawyer may not request an administrative hearing on behalf of a corporation because it constitutes the unauthorized practice of law. The Cabinet argued that because Ms. Branham, Appellee’s CEO, was not a lawyer, it was unlawful for her to request a hearing. If the hearing request was unlawful, the Cabinet’s jurisdiction had not been timely invoked and the appeal of the alleged overpayment should be dismissed. Appellee filed a reply arguing that there is no statute or regulation that requires a hearing request be filed by an attorney, that dismissing the action would violate due process, and that the writing of a letter requesting a hearing is not the practice of law.

On February 13, 2019, the hearing officer entered a recommended order dismissing the case. She concluded that requesting a hearing was the practice of law and had to be undertaken by an attorney on behalf of the corporation. On September 25, 2019, the Secretary of the Cabinet entered a final

order dismissing the overpayment appeal as unauthorized and untimely. The Secretary accepted the Cabinet’s argument that the hearing must be requested by an attorney representing the corporate entity.

On October 21, 2019, Appellee filed an appeal in the Franklin Circuit Court. The parties then briefed the court and on April 21, 2020, the Franklin Circuit Court reversed the final order entered by the Secretary. The court held that simply requesting a hearing was not the practice of law, and it was proper for Appellee’s CEO to request the hearing. The court also held that the Cabinet should be estopped from seeking dismissal because it did not inform Appellee an attorney was required to request a hearing. The court also noted that it had presided over appeals of Medicaid decisions in the past and took judicial notice that the Cabinet had never before taken the position that an attorney for a corporation must be the one to request a hearing. This appeal followed.

ANALYSIS

Upon review of an administrative agency’s adjudicatory decision, an appeal court’s authority is somewhat limited. The judicial standard of review . . . is whether the . . . findings of fact were supported by substantial evidence and whether the agency correctly applied the law to the facts. Substantial evidence is defined as evidence, taken alone or in light of all the evidence, that has sufficient probative value to induce conviction in the minds of reasonable people.

Thompson v. Kentucky Unemployment Ins. Comm’n, 85 S.W.3d 621, 624 (Ky. App. 2002) (citations omitted). “[A]n administrative agency’s findings of fact are reviewed for clear error, and its conclusions of law are reviewed de novo.” Hutchison v. Kentucky Unemployment Ins. Comm’n, 329 S.W.3d 353, 356 (Ky. App. 2010). In the case at hand, whether something is to be considered the practice of law is a question of law; therefore, we review de novo.

The primary issue on appeal, and the issue we believe is determinative, is whether requesting the hearing was the practice of law. The practice of law is defined as follows:

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Cabinet for Health and Family Services Department of Medicaid Services v. Appalachian Hospice Care, Inc., (Ky. Ct. App. 2021).

Cabinet for Health and Family Services Department of Medicaid Services v. Appalachian Hospice Care, Inc. (Cabinet for Health and Family Services Department of Medicaid Services v. Appalachian Hospice Care, Inc.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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416 S.W.2d 727 (Court of Appeals of Kentucky (pre-1976), 1967)
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