Long Island College Hospital v. New York State Department of Health

151 Misc. 2d 370
CourtNew York Supreme Court
DecidedJune 3, 1991
StatusPublished
Cited by1 cases

This text of 151 Misc. 2d 370 (Long Island College Hospital v. New York State Department of Health) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Long Island College Hospital v. New York State Department of Health, 151 Misc. 2d 370 (N.Y. Super. Ct. 1991).

Opinion

[371]*371OPINION OF THE COURT

Elliott Golden, J.

In this CPLR article 78 proceeding, petitioner seeks to recover the income earned on its "Sinking Fund” and on its "Depreciation Construction Funds” that respondents set off against Medicaid reimbursement due petitioner for the years 1985,1986 and 1987.

Initially, the court will consider the validity of petitioner’s alleged 1985 appeal to the Department of Health, the first step of petitioner’s exhausting its administrative remedies prior to instituting this article 78 proceeding.

Respondents contend that "Petitioner did not timely appeal the calculation of its 1985 capital cost reimbursement” and allege "When petitioner was advised of its 1985 capital cost reimbursement,, it was advised that rate appeals must include a cover letter signed by the operator of the hospital” (see, exhibit 2 dated Jan. 20, 1987, that sets forth the requirements for an appeal, particularly the use of respondents’ HE22 forms for appeal; see also, 10 NYCRR 86-1.17 [c] for the requirements of an appeal).

Petitioner did not follow the formal route for its 1985 appeal. Instead petitioner’s accountants (Ernst & Whinney) (not an "operator or chief executive officer”) set forth petitioner’s alleged appeal by letter signed by themselves as accountants for petitioner. Their letter does not contain specific language of appeal as in their letter for petitioner’s 1986 appeal wherein they stated "We are taking advantage of the 'Hot Line’ appeal mechanism”, nor as in their letter for the 1987 appeal wherein they stated "In accordance to [Subpart] 86-1 of the Commissioners Rules and Regulations, the Long Island College wishes to appeal”.

Respondents appear to have disregarded the accountants’ alleged appeal letter. As stated in respondents’ brief "The Ernst & Whinney letter, which petitioner now purports to be its appeal, is not administrative appeal under the regulations, and was never treated as such.” Upon inquiry by petitioner in March 1990, after petitioner received respondents’ determination of petitioner’s 1986 appeal, petitioner was advised by letter of respondents dated April 23, 1990 that "according to our records, no appeal has been received, established and acknowledged for the 1985 rate year. Therefore, this issue for 1985 is considered closed.” Petitioner considers respondents’ letter as the only transmitted final denial of its 1985 appeal [372]*372and, therefore, contends that this article 78 proceeding is timely.

It is undisputed that petitioner’s alleged 1985 appeal did not comply with the requirements of exhibit 2 nor more specifically with the requirements of 10 NYCRR 86-1.17 (c). Petitioner, however, alleges, as respondents’ waiver and nonobservance of the requirements of the regulation, that similar letters of appeal by various hospitals (the accountants claim to represent 1,500 hospitals) were considered by respondents without objection to the letter form of appeal. Petitioner further alleges that its employee in charge of "Medicaid rate appeals pending with DOH [respondent Department of Health] * * * regularly called DOH to inquire as to the status of those two appeals [1985, 1986]. I usually called once a month, but some months I called more often than that * * * On each occasion I was told that the 1985 appeal, together with the 1986 appeal as to the same issue, were being processed and that no determination had been made yet. At no time was I told that [the 1985] appeal * * * had been improperly filed; to the contrary, every indication that I had * * * was that the appeal was routinely processed.”

Although, the respondents are not bound by their later conduct in processing the 1986 and 1987 letter appeals, since a subsequent procedure is not binding on an earlier procedure, nevertheless sufficient facts have been presented to create an issue of respondents’ waiver of the formalities of the regulation. Where "there is a doubt as to the existence of a triable issue [as to the 1985 appeal] or when the issue is arguable since ' "issue finding, rather than issue-determination, is the key to the procedure” ’ ”, a hearing is required (Falk v Goodman, 7 NY2d 87, 91).

If petitioner sustains its burden of proof of respondents’ waiver, then petitioner’s 1985 appeal should be considered in the same manner as petitioner’s 1986 and 1987 appeals, since the basic issues are the same in each appeal.

The issue fundamental to all three appeals is the constitutionality of the amendment to the regulation (10 NYCRR 86-1.23 [b]) that provides "Board-designated funds and the accrual of liabilities to the funded depreciation accounts shall not be recognized as funding of depreciation.” (Emphasis added.)

Respondents’ contention is based on their interpretation of their regulations that interest income and gains on the sale of [373]*373securities of a hospital may be set off against the hospital’s claims of Medicaid reimbursement, except if the funds set up as "Depreciation & Construction Funds” are restricted in their use other than by board of directors’ resolution. "Common among each of these exceptions is a restriction on the hospital’s use of the income beyond the hospital’s control * * * To qualify as income from funded depreciation, the income from such accounts must be restricted by an external source [donors’ limitation on use of funds — lenders’ limitations on use of funds for the replacement of depreciable assets]. If the governing board appropriates resources in this manner, the board may nevertheless have the authority to rescind its action [and therefore] such appropriations should be treated as part of unrestricted funds.”

Respondents further contend that petitioner by its board of directors’ resolution created and funded in 1985, a "Depreciation Fund”, by transferring $10,000,000 to the fund account from other investment accounts. "Although the Board designated the funds in this account 'for purpose of acquiring depreciable assets for use in patient care’ during 1985, 1986 and 1987 rate years, petitioner has acknowledged, in its financial statements, that no amounts were required to be on deposit in the depreciation fund during those years. Moreover, although, the petitioner borrowed $79,750,000 in 1986 to finance $86,445,000 capital project petitioner did not use any of the approximately $12,000,000 on balance in this account for this or any other capital project that year.”

The salutary effect of the amendment is to avoid the difficulty of establishing a retroactive adjustment and to prevent a hospital from receiving a double benefit: reimbursement of its interest expense on its borrowing, while at the same time receiving interest on unrestricted funds, unrestricted to the extent that the board of directors may by new resolution use the accumulated income for its own purposes.

Based on said amendment, respondents set off the interest income from the "Construction Fund” account, stating "Although the corpus of the account is externally restricted for use as collateral, the income from the account is only restricted for capital purposes by designation of the petitioner’s Board of Directors * * * Hence the income on the account has been used to offset reimbursement.” Similarly with respect to the "Depreciation Fund” account — respondents stated "Neither the corpus nor the income from the account is restricted by anyone other then by designation of the petitioner’s Board [374]*374of Directors”.

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Related

Long Island College Hospital v. New York State Department of Health
203 A.D.2d 292 (Appellate Division of the Supreme Court of New York, 1994)

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Bluebook (online)
151 Misc. 2d 370, Counsel Stack Legal Research, https://law.counselstack.com/opinion/long-island-college-hospital-v-new-york-state-department-of-health-nysupct-1991.