Matter of The Plastic Surgery Group, P.C. v. Comptroller of The State of New York

2017 NY Slip Op 8247, 155 A.D.3d 1417, 65 N.Y.S.3d 595
CourtAppellate Division of the Supreme Court of the State of New York
DecidedNovember 22, 2017
Docket525023
StatusPublished

This text of 2017 NY Slip Op 8247 (Matter of The Plastic Surgery Group, P.C. v. Comptroller of The State of New York) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Matter of The Plastic Surgery Group, P.C. v. Comptroller of The State of New York, 2017 NY Slip Op 8247, 155 A.D.3d 1417, 65 N.Y.S.3d 595 (N.Y. Ct. App. 2017).

Opinion

Mulvey, J.

Appeal from an order of the Supreme Court (Ryba, J.), entered July 11, 2016, in Albany County, which granted petitioner’s application pursuant to CPLR 2304 to quash a subpoena duces tecum and denied respondent’s cross motion to compel compliance.

In February 2016, respondent commenced an audit of health insurance claims paid to petitioner by United Health Care to determine if United had overpaid petitioner for claims submitted between 2011 and 2015. Petitioner failed to respond to or comply with respondent’s requests to review a random sample of its records related to such claims. Thereafter, respondent served petitioner with a subpoena duces tecum requesting certain specified documents pertaining to its patients between 2011 and 2015 who were members of the Empire Plan, the primary health insurance plan for the New York State Health Insurance Program (hereinafter NYSHIP). Petitioner is a nonparticipating health care provider * with respect to the Empire Plan that submitted millions of dollars in medical claims to United for patients enrolled in the Empire Plan. United is the private insurance company that contracts with the state to process and pay medical claims for state employees and retirees, among others, who are members of the Empire Plan. United pays the claims and related expenses using funds provided by the state, that is, “the [s]tate funds the Empire Plan as a self-insurer [and] United merely passes state money to the proper payees” (Matter of Martin H. Handler, M.D., P.C. v DiNapoli, 23 NY3d 239, 243 [2014]).

Petitioner did not comply with the subpoena for its records and, instead, commenced this proceeding to quash the subpoena or, alternatively, for a protective order if disclosure were required (see CPLR 2304, 3103). Respondent answered and cross-moved to compel petitioner’s compliance pursuant to CPLR 2308. Supreme Court granted the petition, quashed the subpoena and denied respondent’s cross motion, holding that respondent lacked authority to issue the subpoena because it was not accompanied by the patients’ written authorizations pursuant to CPLR 3122 (a). Respondent appeals.

We reverse. We find that, contrary to petitioner’s claims and the holding of Supreme Court, the subpoena was validly issued in furtherance of respondent’s constitutional and statutory authority and obligation to audit payments made by the state for medical services provided under the Empire Plan (see NY Const, art V, § 1; Civil Service Law § 167 [7]; Matter of Martin H. Handler, M.D., P.C. v DiNapoli, 23 NY3d at 242-243, 247). In Matter of Martin H. Handler, M.D., P.C. v DiNapoli (23 NY3d at 242-243, 245-248), decided well before the subject subpoena was issued, the Court of Appeals outlined the relationship between NYSHIP, United and the Empire Plan, the obligations of participating and nonparticipating health care providers with regard to billing patients, and respondent’s independent authority and obligation to audit the state’s payments to both categories of providers. As the Court of Appeals outlined, respondent is constitutionally obligated to audit state payments to health insurance vendors (id. at 245-246, citing NY Const, art V, § 1) and, further, “the Legislature authorized [respondent] to audit payments to the [s]tate’s health insurance vendors” (Matter of Martin H. Handler, M.D., P.C. v DiNapoli, 23 NY3d at 247, citing Civil Service Law § 167 [7]). Importantly, while subpoenas were not in issue in Handler in that the providers permitted access to their records, the Court recognized that “the Legislature has granted [respondent] broad subpoena powers in furtherance of [its] investigatory functions under State Finance Law § 9” (Matter of Martin H. Handler, M.D., P.C. v DiNapoli, 23 NY3d at 247). To that end, State Finance Law § 9 authorizes respondent to issue a subpoena or subpoenas “in reference to any matter within the scope of the inquiry or investigation being conducted by [respondent]” (see id.). The Court made clear that respondent is mandated to ensure proper billing and payments for the Empire Plan, and to prevent unauthorized payments and overpayments, and must audit the records of participating and nonparticipating providers alike as part of its responsibility to audit payments to medical providers (see id. at 247-248). Thus, the subpoena of petitioner’s records here was well within respondent’s constitutional and statutory authority and consistent with its legal obligations, and represented a valid exercise of its subpoena power (see NY Const, art V, § 1; Civil Service Law § 167 [7]; Matter of Martin H. Handler, M.D., P.C. v DiNapoli, 23 NY3d at 245-248).

Supreme Court’s reliance upon CPLR 3122 (a) (2) as a limitation on respondent’s audit and subpoena authority is misplaced. CPLR 3122 (a) (2), which requires, among other things, that a patient’s written authorization accompany any subpoena duces tecum issued to a medical provider for that patient’s medical records, only applies, by its terms, to subpoenas issued by a party to litigation seeking discovery under CPLR 3120 or 3121, after an action or proceeding is commenced. The plain language of CPLR 3122 (a) (1) and (2), read together, makes clear that the provisions apply to subpoenas issued during the discovery phase of litigation, and are not applicable to the subpoena issued by respondent here pursuant to its authority under State Finance Law § 9 (see Matter of DeVera v Elia, 152 AD3d 13, 19 [2017]). Indeed, the conclusion urged by petitioner would lead to the untenable result that, unless health care providers voluntarily cooperate with respondent’s requests for access to patient records for audit purposes, respondent would be unable to fulfill its statutory and constitutional obligations to audit payments to providers for health insurance claims unless it obtained prior written authorization from all patients whose records were requested. Since respondent’s subpoenas are issued in accordance with its constitutional and statutory audit authority, and have no connection with discovery in an action or proceeding, the cited provisions of CPLR 3122 are not applicable.

We further conclude that disclosure of the records sought by respondent is not barred by the Health Insurance Portability and Accountability Act of 1996 (hereinafter HIPAA) (see 42 USC § 1320d et seq.). HIPAA’s “[p]rivacy [r]ule forbids an organization subject to its requirements (a ‘covered entity’) from using or disclosing an individual’s health information (‘protected health information’) except as mandated or permitted by its provisions” (Arons v Jutkowitz, 9 NY3d 393, 412-413 [2007]; see 45 CFR 160.103). However, HIPAA’s privacy regulations provide that “[a] covered entity may disclose protected health information to a health oversight agency for oversight activities authorized by law, including audits; civil, administrative, or criminal investigations; . . . criminal proceedings or actions; or other activities necessary for appropriate oversight of . . . [e]ntities subject to government regulatory programs for which health information is necessary for determining compliance with program standards,” without the written authorization of the patient (45 CFR 164.512 [d] [1] [iii] [emphasis added]). A health oversight agency is defined, in relevant part, as “an agency or authority of . . .a [s]tate . . .

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Bluebook (online)
2017 NY Slip Op 8247, 155 A.D.3d 1417, 65 N.Y.S.3d 595, Counsel Stack Legal Research, https://law.counselstack.com/opinion/matter-of-the-plastic-surgery-group-pc-v-comptroller-of-the-state-of-nyappdiv-2017.