Mark J. Den Hartog v. Iowa Department of Human Services

CourtCourt of Appeals of Iowa
DecidedApril 26, 2023
Docket22-0273
StatusPublished

This text of Mark J. Den Hartog v. Iowa Department of Human Services (Mark J. Den Hartog v. Iowa Department of Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals of Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Mark J. Den Hartog v. Iowa Department of Human Services, (iowactapp 2023).

Opinion

IN THE COURT OF APPEALS OF IOWA

No. 22-0273 Filed April 26, 2023

MARK J. DEN HARTOG, Plaintiff-Appellant,

vs.

IOWA DEPARTMENT OF HUMAN SERVICES, Defendant-Appellee. ________________________________________________________________

Appeal from the Iowa District Court for Polk County, Celene Gogerty, Judge.

A chiropractor appeals from an Iowa Code chapter 17A (2019) proceeding.

AFFIRMED.

Michael M. Sellers and Trent W. Nelson of Sellers Galenbeck & Nelson,

Clive, for appellant.

Brenna Bird, Attorney General, and Lisa Reel Schmidt, Assistant Attorney

General, for appellee.

Heard by Bower, C.J., and Ahlers and Buller, JJ. 2

AHLERS, Judge.

Mark Den Hartog is a chiropractor who enrolled in the Iowa Medicaid

program and provided chiropractic services to Medicaid patients.1 In 2005 and

2006, an audit revealed Den Hartog’s documentation of services was insufficient

in a number of respects to support payment from Medicaid. Den Hartog was

required to repay several thousand dollars of money received from Medicaid as a

result. Fast forwarding to 2014 and 2015, a federal contractor performed a

Payment Error Rate Measurement (PERM) audit of Iowa Medicaid. As part of the

PERM audit, the contractor randomly requested documents from Den Hartog. Den

Hartog did not provide the necessary documentation. This eventually led to an

audit and administrative proceedings that resulted in the Iowa Department of

Human Services,2 which oversees Iowa’s Medicaid program, terminating Den

Hartog’s participation in the program. The proceeding also resulted in an order

requiring Den Hartog to repay Iowa Medicaid for money he received for Medicaid

services for which Den Hartog was unable to provide the required documentation.

Den Hartog petitioned for judicial review under Iowa Code chapter 17A

(2019).3 The district court found the relevant administrative rules are not

1 Medicaid is a cooperative state-federal program. Colwell v. Iowa Dep’t of Human Servs., 923 N.W.2d 225, 237 (Iowa 2019). The program is “designed to help the states provide medical assistance to financially-needy individuals, with the assistance of federal funding.” Lankford v. Sherman, 451 F.3d 496, 504 (8th Cir. 2006). 2 In 2022, the Iowa Department of Human Services merged with the Iowa

Department of Health to form the Iowa Department of Health and Human Services. Because that had not occurred until after the underlying proceedings of this case, our references to the department are to the Iowa Department of Human Services. 3 Den Hartog brought two separate petitions, one related to termination of his

participation in Medicaid and the other related to the recoupment order, and the district court eventually consolidated them. 3

unconstitutionally vague; Den Hartog received sufficient notice of the issues

addressed in the administrative proceedings; the administrative proceedings did

not violate Iowa Code section 249A.56; and substantial evidence supported that

Iowa Medicaid overpaid Den Hartog and was entitled to repayment.

Den Hartog appeals. He claims he did not receive adequate notice “to

terminate him for a violation of Iowa Administrative Code rule 441-79.3(3)”; “the

department exceeded its authority when it prosecuted [him] for fraud”; “the

department . . . applied the wrong documentation requirement in determining

recoupment and termination of [his] participation in Medicaid”; and, if the

department properly interpreted the documentation requirements, then they are

unconstitutionally vague. Finally, Den Hartog seeks legal fees under

section 625.29. We will address each claim separately, although not necessarily

in order.

I. Scope and Standard of Review

When reviewing a judicial review action, “our job is to determine whether in

applying the applicable standards of review under section 17A.19(10), we reach

the same conclusions as the district court.” Colwell, 923 N.W.2d at 231. “The

petitioner challenging agency action has the burden of demonstrating the prejudice

and invalidity of the challenged agency action.” Id.

The applicable standard of review depends upon the error asserted by the petitioner. When the legislature has clearly vested interpretive authority with an agency, we defer to the agency’s interpretation of the statutory language and reverse only when the agency’s interpretation is “irrational, illogical, or wholly unjustifiable.” However, when the legislature has not clearly vested interpretive authority with an agency, our standard of review is for errors of law. “To determine whether an agency has been given authority to interpret statutory language, ‘we carefully consider “the specific 4

language the agency has interpreted as well as the specific duties and authority given to the agency”’” regarding the particular statutes.

Id. at 231–32 (internal citations omitted). With respect to Den Hartog’s

constitutional challenges to various administrative rules, our review is de novo.

See Endress v. Iowa Dep’t of Human Servs., 944 N.W.2d 71, 76 (Iowa 2020).

Regarding the request for attorney fees, we review for legal error. See id.

II. Notice

We first address Den Hartog’s contention that the department could not

terminate his participation in Medicaid due to a violation of Iowa Administrative

Code rule 441-79.3 because the rule was not specifically referenced in the notice

of termination. The written notice of termination explained that the department was

authorized to terminate Den Hartog’s participation in Medicaid under Iowa

Administrative Code rule 441-79.2(2), which permits the imposition of sanctions

for the following relevant conduct:

a. Presenting or causing to be presented for payment any false, intentionally misleading, or fraudulent claim for services or merchandise. b. Submitting or causing to be submitted false, intentionally misleading, or fraudulent information for the purpose of obtaining greater compensation than that which the person is legally entitled, including charges in excess of usual and customary charges. .... i. Violating any provision of Iowa Code chapter 249A, or any rule promulgated pursuant thereto, or violating any federal or state false claims Act, including but limited to Iowa Code chapter 685. .... l. Breaching any settlement or similar agreement with the department, or failing to abide by the terms of the agreement with any other entity relating to, or arising out of, the state medical assistance program.

The director ultimately found Den Hartog’s termination was authorized under

rule 441-79.2(2)(i) and (l). The director determined Den Hartog violated 5

paragraph (i) by “failing to comply with the recordkeeping requirements within

rule 441-79.3.” With respect to paragraph (l), the director determined Den Hartog

violated a 2010 provider agreement because the agreement required Den Hartog

to “maintain books, records and documents which sufficiently and properly

document and calculate all charges billed to the [d]epartment.”

Den Hartog complains that he did not understand the department based its

decision to terminate his participation in Medicaid due to his failure to comply with

documentation requirements and instead read the notice as terminating his

participation due to fraud. But that is not the department’s fault.

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