HCMC, Inc. v. Ohio Department of Job & Family Services

903 N.E.2d 660, 179 Ohio App. 3d 707, 2008 Ohio 6223
CourtOhio Court of Appeals
DecidedDecember 2, 2008
DocketNo. 08AP-144.
StatusPublished
Cited by7 cases

This text of 903 N.E.2d 660 (HCMC, Inc. v. Ohio Department of Job & Family Services) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
HCMC, Inc. v. Ohio Department of Job & Family Services, 903 N.E.2d 660, 179 Ohio App. 3d 707, 2008 Ohio 6223 (Ohio Ct. App. 2008).

Opinion

Petree, Judge.

{¶ 1} Appellant and cross-appellee, Ohio Department of Job and Family Services (“ODJFS,” or “agency”), appeals from a judgment of the Franklin County Court of Common Pleas that reversed an order of ODJFS and remanded the matter to the agency. Appellee and cross-appellant, HCMC, Inc., d.b.a. We Care Medical (“HCMC”), cross-appeals. For reasons that follow, we affirm in part and reverse in part the judgment of the common pleas court and remand the matter to the common pleas court.

{¶ 2} HCMC is a company that provides oxygen respiratory services. Between November 2004 and November 2005, the Ohio Auditor of State audited Medicaid reimbursements that were made to HCMC for the period of October 1, 2001, through June 30, 2004. During the period under audit, HCMC received reimbursements totaling $1,436,907.52 for 7,993 claims. According to the state auditor’s report, the scope of the audit was limited to claims, not involving Medicare copayments, for which HCMC rendered services to Medicaid patients, and all of HCMC’s reimbursements were for the supply of oxygen concentrator services to Medicaid residents in long-term care facilities.

{¶ 3} After reviewing HCMC’s Medicaid services, the state auditor determined that HCMC had received $1,010,404.26 in overpayments and separated the results into “exception testing” and “usual and customary” categories. 1 ODJFS thereafter issued a proposed adjudication order with a demand that HCMC repay $1,010,404.26, plus interest.

*712 {¶ 4} Challenging factual and legal conclusions of the audit, HCMC requested an administrative hearing pursuant to R.C. Chapters 119 and 5111. After conducting an administrative hearing, a hearing examiner issued a report and recommendation, wherein the hearing examiner concluded that HCMC owed the full amount identified in the audit. Objecting to this report and recommendation, HCMC sought relief from ODJFS. Adopting the hearing examiner’s findings of fact, conclusions of law, and recommendation, the director of ODJFS rejected HCMC’s objections and issued an adjudication order directing HCMC to repay $1,010,404.26, plus interest.

{¶ 5} From this order, ODJFS appealed to the Franklin County Court of Common Pleas. On condition that HCMC post a supersedeas bond in the amount of $200,000, the common pleas court stayed enforcement of the adjudication order. Later, the common pleas court reversed the agency’s adjudication order and remanded the matter to ODJFS to calculate a “usual and customary” charge based on the common pleas court’s findings and conclusions. From the common pleas court judgment, ODJFS appeals and HCMC cross-appeals.

{¶ 6} Upon ODJFS’s unopposed motion, this court permitted ODJFS to collect $34,250.10, plus applicable interest from HCMC, thereby excepting an amount from the common pleas court’s stay order that represented the “exception testing” portion of the state’s audit.

{¶ 7} In its appeal, ODJFS advances four assignments of error, as follows:

First Assignment of Error
The trial court erred by ordering further factual development of appellant’s cost calculations when the appellant “chose not to supply more detailed information on its cost calculations” during the audit or the administrative hearing.
Second Assignment of Error
The lower court erred when it concluded that oxygen services provided to Medicaid and non-Medicaid patients are different because the oxygen supply company bills the nursing home and terms the service a rental.
Third Assignment of Error
The lower court erred when it ordered ODJFS to pay a surcharge to compensate a Medicaid provider for its “overhead.”
Fourth Assignment of Error
The trial court erred by staying enforcement of an entire adjudication order where the Medicaid provider stipulated that it was required to repay a specific amount.

{¶ 8} On cross-appeal, HCMC advances the following two assignments of error:

*713 Cross-Appeal Assignment Of Error No. I:

The trial court erred by remanding this matter to the department.

Cross-Appeal Assignment Of Error No. II:

The trial court abused its discretion when it failed to reverse the department’s decision to exclude relevant evidence offered by HCMC at hearing.

{¶ 9} For ease of review, we shall address ODJFS’s and HCMC’s claims of error in a different order from the sequence offered by the parties. We shall begin, however, by sua sponte considering whether this court has subject-matter jurisdiction to consider ODJFS’s appeal.

{¶ 10} An appellate court may sua sponte consider whether subject-matter jurisdiction properly lies. State ex rel. White v. Cuyahoga Metro. Hous. Auth. (1997), 79 Ohio St.3d 543, 544, 684 N.E.2d 72; Buzard v. Triplett, Franklin App. No. 05AP-579, 2006-Ohio-1478, 2006 WL 772024, at ¶ 7; Mogavero v. Lombardo (Sept. 25, 2001), Franklin App. No. 01AP-98, 2001 WL 1117542. Subject-matter jurisdiction is a condition precedent to a court’s ability to consider a case. Absent subject-matter jurisdiction, a court’s proclamation is void. See State ex rel. Ohio Democratic Party v. Blackwell, 111 Ohio St.3d 246, 2006-Ohio-5202, 855 N.E.2d 1188, at ¶ 8, quoting Pratts v. Hurley, 102 Ohio St.3d 81, 2004-Ohio-1980, 806 N.E.2d 992, at ¶ 11, quoting State ex rel. Tubbs Jones v. Suster (1998), 84 Ohio St.3d 70, 75, 701 N.E.2d 1002, reconsideration denied (1999), 84 Ohio St.3d 1475, 704 N.E.2d 582 (“ ‘[subject-matter jurisdiction] is a “condition precedent to the court’s ability to hear the case. If a court acts without jurisdiction, then any proclamation by that court is void.” ’ ”).

{¶ 11} Fundamental to ODJFS’s appeal is a contention that the common pleas court incorrectly interpreted ODJFS’s administrative rules. R.C. 119.12 provides:

An appeal by the agency shall be taken on questions of law relating to the constitutionality, construction, or interpretation of statutes and rules of the agency, and, in the appeal, the court may also review and determine the correctness of the judgment of the court of common pleas that the order of the agency is not supported by any reliable, probative, and substantial evidence in the entire record.

{¶ 12} In its decision, the common pleas court stated:

It is * * * concluded that the audit did not compare rates for the same service. While the audit may constitute prima facie evidence, nothing prohibits review of the underlying premises upon which the audit is based. The Court has considered the applicable rules in pari materia and finds Appellant’s interpretation legally correct. Phraseology of “usual and customary fee charged to patients for the same service” does not comport with construing rental of *714

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Bluebook (online)
903 N.E.2d 660, 179 Ohio App. 3d 707, 2008 Ohio 6223, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hcmc-inc-v-ohio-department-of-job-family-services-ohioctapp-2008.