Golden Gate National Senior Care, LLC d/b/a Golden Living v. Indiana Family and Social Services Administration (mem. dec.)

CourtIndiana Court of Appeals
DecidedFebruary 10, 2020
Docket19A-PL-1269
StatusPublished

This text of Golden Gate National Senior Care, LLC d/b/a Golden Living v. Indiana Family and Social Services Administration (mem. dec.) (Golden Gate National Senior Care, LLC d/b/a Golden Living v. Indiana Family and Social Services Administration (mem. dec.)) is published on Counsel Stack Legal Research, covering Indiana Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Golden Gate National Senior Care, LLC d/b/a Golden Living v. Indiana Family and Social Services Administration (mem. dec.), (Ind. Ct. App. 2020).

Opinion

MEMORANDUM DECISION Pursuant to Ind. Appellate Rule 65(D), this Memorandum Decision shall not be FILED regarded as precedent or cited before any Feb 10 2020, 10:44 am court except for the purpose of establishing the defense of res judicata, collateral CLERK Indiana Supreme Court Court of Appeals estoppel, or the law of the case. and Tax Court

ATTORNEYS FOR APPELLANT ATTORNEYS FOR APPELLEE Norris Cunningham Curtis T. Hill, Jr. Kathryn Elias Cordell Attorney General of Indiana Katz Korin Cunningham PC Benjamin M. L. Jones Indianapolis, Indiana Deputy Attorney General Indianapolis, Indiana

IN THE COURT OF APPEALS OF INDIANA

Golden Gate National Senior February 10, 2020 Care, LLC d/b/a Golden Living, Court of Appeals Case No. Appellant-Petitioner, 19A-PL-1269 Appeal from the Marion Superior v. Court The Honorable Cynthia J. Ayers, Indiana Family and Social Judge Services Administration, Trial Court Cause No. Appellee-Respondent. 49D04-1802-PL-5532

Bailey, Judge.

Court of Appeals of Indiana | Memorandum Decision 19A-PL-1269 | February 10, 2020 Page 1 of 19 Case Summary [1] Golden Gate National Senior Care, LLC d/b/a Golden Living (“Golden”)

submitted Nursing Facility Financial Reports (to be used in accordance with

405 IAC 1-14.6)1 to the Office of Medicaid Policy and Planning (“OMPP”), a

division of the Indiana Family and Social Services Administration (“FSSA”).

After OMPP auditors made changes to the entries ultimately reducing

reimbursement, Golden pursued an administrative appeal of the revisions. An

Administrative Law Judge (“ALJ”) denied Golden relief; a designee of ultimate

authority for the FSSA adopted the ALJ decision without modification; Golden

petitioned the Marion County Superior Court for judicial review; the trial court

upheld the agency decision; and Golden now appeals. We affirm.

Issues [2] Golden presents two issues for review:

I. Whether Golden was denied due process in the hearing before the ALJ; and

II. Whether the order on petition for judicial review is contrary to law.

1 This section of the Indiana Administrative Code sets forth payment procedures and rate setting criteria for nursing facilities.

Court of Appeals of Indiana | Memorandum Decision 19A-PL-1269 | February 10, 2020 Page 2 of 19 Facts and Procedural History [3] Golden owns and operates multiple long-term care facilities throughout the

State of Indiana. As an authorized provider of Medicaid-covered services,

Golden is required to submit for each facility and year of operation a form titled

Nursing Facility Financial Report. The forms are to be used in accordance with

the provisions of 405 IAC 1-14.6 and an instruction booklet is provided to

promote compliance. The reports are audited by Myers & Stauffer, accountants

contracted by the OMPP (“Auditors”). This case involves disputes between the

care provider and Auditors as to proper categorization of cost items reported on

the forms for rate years 2011 and 2014.

[4] When the Auditors reviewed Golden’s cost reports for those years, they

determined that certain items on twenty-two reports should be reclassified or

disallowed. Specifically, costs reported as direct care costs incurred by 360

Healthcare and Clinical Services, two entities related to Golden,2 were

reclassified as if they had been incurred directly by Golden (by placement into

subcategories of capital, plant operations, and administration). A software-

related item was moved from amortization of a capitalized cost to a category

for depreciation of building and fixtures. Reported costs for software

maintenance and software license fees were moved from a “repairs and

2 Pursuant to IAC 1-14.6-2(ff), a party is a related party when the provider is associated or affiliated with or has the ability to control or be controlled by the organization furnishing the service, facilities, or supplies, regardless of whether control is actually exercised.

Court of Appeals of Indiana | Memorandum Decision 19A-PL-1269 | February 10, 2020 Page 3 of 19 maintenance” category to “other administrative costs.” Appealed Order at 2.

A reported cost for medical equipment rental was moved from a “direct care”

category to an “equipment lease/rent” category. Id. The changes ultimately

resulted in a reduced reimbursement to Golden, estimated to be approximately

one million dollars.

[5] Golden asked for reconsideration from the Auditors, but on July 16, 2013, the

Auditors issued a reconsideration response letter without making any further

adjustment. On September 13, 2013, Golden filed a Petition for Review and

Request for Hearing with the OMPP. Golden articulated five issues for review,

specifically, whether the Auditors improperly reclassified: (1) expenses reported

as direct care costs of Clinical Services for clinical and dietary consulting

services; (2) expenses reported as direct care costs of 360 Healthcare, a

temporary staffing agency; (3) software development amortization, reported as

a capital component; (4) software maintenance; and (5) costs for durable

medical equipment. Golden alleged that the Auditors failed to identify

applicable administrative rules justifying their changes.

[6] The ALJ conducted a telephonic appeal hearing on September 7, 2016. Golden

presented two witnesses to explain the bases for Golden’s reporting and OMPP

presented the testimony of an accountant. Golden conceded that 360

Healthcare and Clinical Services Argument were entities related to Golden but

argued that the reported costs reflected no profit margin and there were no

inflated costs.

Court of Appeals of Indiana | Memorandum Decision 19A-PL-1269 | February 10, 2020 Page 4 of 19 [7] As for the treatment of software costs, Golden argued that the Auditors’

decisions lacked specificity and were not supported by appropriate authority.

By the time of the hearing, OMPP had issued a bulletin changing its position on

treatment of durable medical equipment. Prospectively, OMPP allowed

specified rental equipment to be included as a direct care cost. To provide some

retroactive relief, OMPP had created a settlement pool; however, claimants

were able to claim additional compensation retroactive only to October 1, 2011.

Golden argued that reimbursement should have been retroactive to July 1,

2011, the beginning of the administrative agency fiscal year.

[8] OMPP’s witness conceded that former auditors may have treated certain items

differently, and that the Auditors made some changes in light of revised

research. However, he maintained that the Auditors attempted to discern the

most appropriate category and all providers were treated uniformly. As for

durable medical equipment reimbursement, OMPP took the position that it was

not required by law to utilize the fiscal year start preferred by Golden.

[9] On September 28, 2016, the ALJ issued a ruling denying Golden relief. In

relevant part, the findings and conclusions thereon provide:

[Findings]

I find that Clinical and 360 are related companies to Golden Living.

Court of Appeals of Indiana | Memorandum Decision 19A-PL-1269 | February 10, 2020 Page 5 of 19 I find that as related companies the costs incurred relative to Clinical and 360 must be reported in the same way as if the costs had been incurred by Golden Living itself.

Golden Living is required to report its costs on the specific lines relative to those costs, i.e.

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