Liberty Nursing Home, Inc. v. Director, Virginia Department of Medical Assistance Services

45 Va. Cir. 534, 1998 Va. Cir. LEXIS 127
Roanoke County Circuit Court·Decided June 9, 1998·No. Case No. CL97-829·Published·Cited by 1 cases

Opinion

BY JUDGE ROBERT P. DOHERTY, JR.

Plaintiffs, Liberty Nursing Home, Inc., et al., contracted with the Commonwealth of Virginia through the Virginia Medical Assistance Program, now Virginia Medical Assistance Services, the Defendant in this administrative appeal, to provide nursing home services to Medicaid patients commencing in late 1979. On July 19, 1990, the Defendant notified the Plaintiffs that it had overpaid them approximately one million dollars since 1979 and was seeking reimbursement. This determination of overpayment was based on a reimbursement/payment formula which the Plaintiffs dispute. A statutory informal fact-finding conference found in favor of the Defendant. The Plaintiffs, not consenting to that decision, requested a formal de novo hearing pursuant to Va. Code § 9-6.14:12. The hearing officer made findings of fact and law consistent with the Plaintiffs position, which the Director of the agency reversed. Plaintiffs’ appeal of that decision, as well as the construction and application of the time limitations contained in § 32.1-325.1:1(B) is now before this Court for review. The Court vacates and remands the Director’s factual determination and reverses his ruling on the statute of limitations.

[535] The Director’s Findings of Fact

“[T]he circuit court’s role in an appeal from an agency decision is equivalent to an appellate court’s role in an appeal from a trial court.” School Board of York County v. Nicely, 12 Va. App. 1051 (1991). The agency findings of fact are to be accorded great deference under the substantial evidence standard of review. J.P. v. Carter, 24 Va. App. 707 (1997). A “reviewing court may reject an agency’s findings of fact only if, considering the record as a whole, a reasonable mind would necessarily come to a different conclusion.” Johnston-Willis v. Kenley, 6 Va. App. 231 (1988). Judicial interference is allowed in these cases “only for relief against the arbitrary or capricious action that constitutes a clear abuse of the delegated discretion.” Environmental Defense Fund, Inc. v. Virginia State Water Control Bd., 15 Va. App. 271 (1992). However, “even though an agency’s finding of fact may be supported by substantial evidence in the record, it may be subject to reversal because the agency failed to observe required procedures or to comply with statutory authority.” Johnston-Willis, supra at 243.

In this case, the great deference accorded the agency Director’s findings of fact has been nullified by the Director’s failure to comply with statutory authority. The agency did not give deference as required by § 9-6.14:12 to the findings by the presiding hearing officer, even though they were explicitly based on the demeanor of witnesses. Instead, the agency arbitrarily and capriciously rejected all of the findings of fact and recommendations of the hearing officer, on the grounds that “he fundamentally misconstrued and misunderstood the procedural stature of an administrative appeal.” This determination by the agency Director was based on the Director’s belief that the deference afforded the agency’s prior interpretation of its own rules and regulations was and is absolute and overcomes any evidence to the contrary.

If that were the case, there would be no need for the administrative appeal process. This deference is not absolute but is instead a starting point. It is because of this due regard for the findings of the agency in its day-to-day interpretation of facts and rules that agency rulings are presumed to be correct. This presumption of correctness is the reason the burden is on the Plaintiff to prove that the agency decision, which was initially appealed to the Director, was wrong. Such a presumption of correctness, however, is not sufficient to overcome the hearing officer’s findings of fact. If the Director alters those findings of facts, any such alteration must contain specific and adequate reasons for determining the credibility of the witnesses differently than that found by the hearing officer. The findings of the hearing officer [536] must be given deference and should be sustained, unless plainly wrong and not supported by the evidence. Jamison v. Jamison, 3 Va. App. 644 (1987). Accordingly, the Director’s findings of fact are vacated, and this matter is remanded for a new factual determination in keeping with this opinion.

Statute of Limitations

The Defendant argues that (1) § 32.1-325.1:1 does not contain a statute of limitations; (2) that the word “shall” in the statute is not mandatory but is merely directory; (3) that the language dealing with a time limitation actually has no meaning; (4) that if this code section does contain a statute of limitation, the general rule is that it will not run against the Commonwealth as its language is not express; (5) and finally, if it is a statute of limitations, to apply it in this case would constitute an unpermissive retroactive application. The Plaintiff claims that the statute contains a four-year statute of limitations that is binding on the Commonwealth. That portion of § 32.1-235.1:1, the meaning of which the parties cannot agree upon, is:

B. The Director of Medical Assistance Services shall collect by any means available to him at law any amount owed to the Commonwealth because of overpayment for medical assistance services. Upon making an initial determination that an overpayment has been made to the provider pursuant to § 32-1.325.1, the Director shall notify the provider of the amount of the overpayment. Such initial determination shall be made within the earlier of (i) four years, or (ii) fifteen months after filing of the final cost report by the provider subsequent to the sale of the facility or termination of the provider.

(Emphasis added.)

The specific part of the statute which is in dispute is the italicized phrase. The Court finds that the Commonwealth is limited by this language, but for a different reason and in a different manner than that which the parties have argued.

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

Liberty Nursing Home, Inc. v. Director, Virginia Department of Medical Assistance Services, 45 Va. Cir. 534, 1998 Va. Cir. LEXIS 127 (Va. Super. Ct. 1998).

45 Va. Cir. 534 (Liberty Nursing Home, Inc. v. Director, Virginia Department of Medical Assistance Services) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related