Care Providers of Minnesota, Inc. v. Gomez

545 N.W.2d 45, 1996 Minn. App. LEXIS 320, 1996 WL 118063
CourtCourt of Appeals of Minnesota
DecidedMarch 19, 1996
DocketNo. C9-95-2012
StatusPublished

This text of 545 N.W.2d 45 (Care Providers of Minnesota, Inc. v. Gomez) is published on Counsel Stack Legal Research, covering Court of Appeals of Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Care Providers of Minnesota, Inc. v. Gomez, 545 N.W.2d 45, 1996 Minn. App. LEXIS 320, 1996 WL 118063 (Mich. Ct. App. 1996).

Opinion

OPINION

DAVIES, Judge.

Wedgewood Health Care Center, Inc., and EWL Enterprises, Inc., d/b/a Golden Oaks Nursing Home (the providers), appeal the district court’s denial of declaratory and permanent injunctive relief against the Minnesota Department of Human Services (DHS).1 We affirm.

FACTS

DHS administers Minnesota’s participation in the federal Medicaid funding program for long-term and intermediate health care facilities. The federal share of the funding is approximately 55 percent.

Medical assistance providers are reimbursed at a rate that is established each year for each facility. DHS initially approves a provider’s rate based on a desk audit (a quick, paper review) of the provider’s reported costs. Later, a DHS field audit (a more intense, on-site examination of records) may disallow certain costs claimed by the provider. Absent appeal, the provider must repay the disallowed costs.

If a provider appeals a field audit, the DHS Commissioner reviews the audit and issues a written determination. A provider can appeal this written determination by demanding a contested case hearing.

In 1993, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services conducted an inspection audit of DHS’s claimed Medicaid costs. The audit focused first on whether DHS properly identified overpayments to care facilities and second on whether DHS timely reimbursed the federal government for overpayments. The OIG report concluded that DHS had “unnecessarily delayed” refund of the federal share of overpayments until all appeal procedures were exhausted. This DHS practice was found to be “contrary to Federal regulations.”

In response to the OIG report, DHS proposed that it begin paying back the federal share of overpayments on the date the written determination was issued. The federal auditor agreed to such an arrangement, and DHS has begun issuing immediate assessment letters to providers that requested a contested case hearing; the letters are sent long before appeal procedures are completed.

Golden Oaks and Wedgewood, nursing homes that participate in the medical assistance program, commenced contested cases to appeal DHS audits for rates paid from 1989 to 1993. At issue in the appeals is the allowance of extraordinary bonuses paid to the nursing homes’ owners. DHS issued assessment letters to the nursing homes indicating that reimbursement of the federal share of the alleged overpayments was due immediately, $254,165 for Wedgewood and $35,932 for Golden Oaks.

The providers, along with Care Providers of Minnesota, Inc. (their trade association), initiated this suit to enjoin DHS from recovering the federal overpayments before resolution of the contested case hearings. The district court initially issued a temporary restraining order against the new DHS procedure but, following a hearing, dissolved the temporary restraining order and denied the providers’ motion for declaratory and permanent injunctive relief. This appeal followed.

ISSUES

I. Does Minn.Stat. § 256B.0641 require DHS to recover the federal share of overpay-ments from a provider when the federal government recovers its share from DHS, even before the provider’s appeal of the alleged overpayment has been resolved?

II. Do DHS assessment letters for the federal share of alleged overpayments constitute unpromulgated rules?

[47]*47ANALYSIS

In this case, the district court’s denial of an injunction was based on its interpretation of a statute. The construction of a statute is a question of law and is reviewed de novo. Sorenson v. St. Paul Ramsey Medical Ctr., 457 N.W.2d 188, 190 (Minn.1990). It is appropriate to defer to DHS’s interpretation of its governing statute. See Krumm v. R.A. Nadeau Co., 276 N.W.2d 641, 644 (Minn.1979) (when meaning of governing-statute is doubtful, courts should give great weight to interpretation by department charged with its administration).

I.

Minn.Stat. § 256B.72 (1994) provides:

The commissioner shall not recover over-payments from medical assistance vendors if an administrative appeal or judicial action challenging the proposed recovery is pending.

Pursuant to this provision, prior DHS practice was to defer attempts to recover an overpayment from a provider until the provider’s appeal of an overpayment claim was resolved. But:

Notwithstanding section 256B.72 or any law or rule to the contrary * ⅜ *
(1) if the federal share of the overpayment amount is due and owing to the federal government under federal law and regulations, the commissioner shall recover from the medical assistance vendor the federal share of the determined overpayment amount paid to that provider using the schedule of payments required by the federal government; * ⅜ ⅜.

Minn.Stat. § 256B.0641, subd. 1 (Supp.1995) (emphasis added). Thus, despite Minn.Stat. § 256B.72, state law requires DHS to recoup from the provider the federal share of over-payments as soon as the state refunds that share to the federal government.

Federal regulations, enjoying supremacy, set the following schedule for payment:

[Tjhe Medicaid agency has 60 days from the date of discovery of an overpayment to a provider to recover or seek to recover the overpayment before the Federal share must be refunded * * * whether or not the State has recovered the overpayment from the provider.

42 C.F.R. § 433.312(a) (1993) (emphasis added). The regulations then explain:

An overpayment resulting from a situation other than fraud or abuse is discovered on
(1) The date on which any Medicaid agency official or other State official first notifies a provider in writing of an overpayment and specifies a dollar amount that is subject to recovery.

42 C.F.R. § 433.316(c) (1993).

The providers contend that it is improper to use the date the written determination is issued as the “date of discovery” in instances in which they demand a contested ease hearing. The providers point to Minnesota’s statutory language:

When a contested case demand is referred to the office of the attorney general, the contested case procedures described in subdivision lc apply and the written determination issued by the commissioner is of no effect.

Minn.Stat. § 256B.50, subd. 1h(d) (1994) (emphasis added). According to the providers, if state law says the written determination has “no effect,” it is illogical for it to serve as the discovery date triggering the 60-day period for reimbursing the federal share of payments.

We conclude, however, that this statute is inconsistent with, and thus superseded by, federal regulations. Those regulations provide that “[a]ny appeal rights extended to a provider do not extend the date of discovery.” 42 C.F.R.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Perales v. Heckler
762 F.2d 226 (Second Circuit, 1985)
Sorenson v. St. Paul Ramsey Medical Center
457 N.W.2d 188 (Supreme Court of Minnesota, 1990)
Krumm v. R. A. Nadeau Co.
276 N.W.2d 641 (Supreme Court of Minnesota, 1979)
Mapleton Community Home, Inc. v. Minnesota Department of Human Services
391 N.W.2d 798 (Supreme Court of Minnesota, 1986)

Cite This Page — Counsel Stack

Bluebook (online)
545 N.W.2d 45, 1996 Minn. App. LEXIS 320, 1996 WL 118063, Counsel Stack Legal Research, https://law.counselstack.com/opinion/care-providers-of-minnesota-inc-v-gomez-minnctapp-1996.