Cortlandt Nursing Home v. Axelrod

99 A.D.2d 105, 472 N.Y.S.2d 737, 1984 N.Y. App. Div. LEXIS 16525
CourtAppellate Division of the Supreme Court of the State of New York
DecidedFebruary 2, 1984
StatusPublished
Cited by16 cases

This text of 99 A.D.2d 105 (Cortlandt Nursing Home v. Axelrod) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cortlandt Nursing Home v. Axelrod, 99 A.D.2d 105, 472 N.Y.S.2d 737, 1984 N.Y. App. Div. LEXIS 16525 (N.Y. Ct. App. 1984).

Opinion

OPINION OF THE COURT

Weiss, J.

We hold today that while the six-year time limitation in CPLR 213 does not bar State actions to recoup alleged [106]*106Medicaid overpayments taken wholly within the administrative process, such actions may, nevertheless, properly be enjoined when an inordinate amount of time has elapsed between the alleged overpayments and the commencement of recoupment.

In these consolidated CPLR article 78 proceedings commenced by three licensed residential health care facilities, Special Term permanently enjoined the State from undertaking further action to recoup alleged Medicaid overpayments, holding that the claims were each for money had and received and time barred by the six-year Statute of Limitations. Under the methodology employed, the Medicaid reimbursement rate for each facility is established prospectively by review of operating costs for a prior base period trended to allow for inflation. The base year cost reports are subsequently audited by the Department of Health (see 10 NYCRR 86-2.7) and retroactive rate adjustments made when overpayments are discovered. The nursing home operator may request modifications of an audit and, thereafter, initiate a full bureau review (10 NYCRR 86-2.7 [d], [e]). There is entitlement to a full-scale administrative hearing in conformity with the State Administrative Procedure Act (10 NYCRR 86-2.7 [f]). The State can initiate recoupment prior to a hearing but must, within a reasonable time thereafter, commence the administrative hearing (Clove Lakes Nursing Home v Whalen, 45 NY2d 873; Niagara Falls Mem. Med. Center v Axelrod, 88 AD2d 777). CPLR article 78 review is available to review a final administrative determination.

In proceeding No. 1, the Department of Health did not complete its audit of the 1969 and 1970 reports submitted by petitioner Cortlandt Nursing Home until March, 1976. The audit disallowed certain expenses for which petitioner had been reimbursed in its rate period ending June 30, 1972. It was not until June 25, 1979 that hearings on petitioner’s administrative appeal were commenced, culminating in an order on January 26,1982, almost 12 years later, revising rates for the period ending June 30,1972. In proceeding No. 2, petitioner King Street Home, Inc., was notified in March, 1977 that the Department of Health’s audit of the 1970 cost report, and in April, 1978 that the [107]*107audit of the 1971 through 1973 cost reports, both resulted in retroactive revisions of the reimbursement rate for periods from July 1, 1971 through March 31, 1975. Hearings upon that petitioner’s administrative appeal were not scheduled until May, 1982, again almost 10 years after payments had been made. In proceeding No. 3, the audit of petitioner Highland Nursing Home, Inc.’s 1970 through 1972 cost reports was not completed until June 1, 1976, at which time the Department of Health notified petitioner that rate adjustments would be made. On the appeal from that petitioner’s CPLR article 78 proceedings seeking a declaratory judgment and an injunction against retroactive rate revisions without a hearing, this court held that recoupment could begin on the condition that a hearing be conducted by the Department of Health upon petitioner’s administrative appeal within 90 days of the commencement of recoupment (Portnick v Whalen, 65 AD2d 827). Although no hearing has been held, the department commenced recoupment in April, 1982. It is from three separate judgments, each permanently enjoining the Department of Health from undertaking any further steps to recoup the alleged Medicaid overpayments, that respondents have brought these consolidated appeals.

Our determination requires that we first address the issue of whether the civil Statute of Limitations in CPLR 213 (subd 2) concerning money actions can bar State action to recoup Medicaid overpayments effectuated wholly within the administrative process. It is beyond cavil that the State’s attempted recoupment is not an “action” (see CPLR 105, subd [b]). The Court of Appeals has clearly stated that “an administrative proceeding is not an action” (Matter of Fiedelman v New York State Dept. of Health, 58 NY2d 80, 82). Special Term, therefore, erred in holding that CPLR 213 (subd 2) imposed a six-year limitation of time within which the State could seek recovery of overpayment by recoupment, and that portion of each judgment which granted so much of the petitions as sought a declaration that the Department of Health’s actions were illegal must be reversed.

We reach a contrary conclusion, however, with respect to that portion of each judgment which enjoined recoupment [108]*108or attempted recoupment. For the reasons herein stated, we affirm the permanent injunction granted in each judgment. Respondents, citing City of New York v State of New York (40 NY2d 659, 668), contend that the audit procedures initiated within six years of filing of the annual cost reports were timely

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Bluebook (online)
99 A.D.2d 105, 472 N.Y.S.2d 737, 1984 N.Y. App. Div. LEXIS 16525, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cortlandt-nursing-home-v-axelrod-nyappdiv-1984.