Medical Services Administration v. Duke

378 So. 2d 685
CourtSupreme Court of Alabama
DecidedSeptember 28, 1979
Docket78-45
StatusPublished
Cited by9 cases

This text of 378 So. 2d 685 (Medical Services Administration v. Duke) is published on Counsel Stack Legal Research, covering Supreme Court of Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Medical Services Administration v. Duke, 378 So. 2d 685 (Ala. 1979).

Opinion

378 So.2d 685 (1979)

The MEDICAL SERVICES ADMINISTRATION of the State of Alabama et al.
v.
Henry Patrick DUKE et al.

78-45.

Supreme Court of Alabama.

September 28, 1979.
Rehearing Denied December 7, 1979.

*686 Charles A. Graddick, Atty. Gen., Joseph M. Carlton, Jr., Asst. Atty. Gen., for appellants.

Nicholas T. Braswell, III, Montgomery, for appellees.

PER CURIAM.

The issue before us on this appeal is whether the trial court erred in determining that the administrative hearing of November 22, 1977, as reconvened on November 29, 1977, was unconstitutionally conducted and of no effect and, in determining that Duke was due to be reinstated as a "Medicaid provider." We conclude that the trial judge did not err and that his judgment should be affirmed.

Specifically, the trial judge concluded that Duke was not given adequate notice of the "fair hearing," was not adequately informed of the charges made against him, was denied the opportunity to fully cross-examine the witnesses against him, and was not allowed to see or examine documentary evidence used against him.

We need only consider the first finding of the trial court, namely, whether Duke was given adequate notice of the "fair hearing" in order to satisfy the requirements of due process. We agree with the trial court that Duke was not given adequate notice of the "fair hearing" and was not adequately informed of the charges made against him.

It is, of course, well-settled law in this jurisdiction that due process must be observed by all boards, as well as by all courts. State Tenure Commission v. Madison County Board of Education, 282 Ala. 658, 213 So.2d 823 (1968); Katz v. Alabama State Bd. of Medical Examiners, 351 So.2d 890 (Ala.1977). "Procedural due process in this respect requires at a minimum an orderly proceeding appropriate to the case or adapted to its nature, just to the parties affected, and adapted to the ends to be attained; one in which a person has an opportunity to be heard, and to defend, enforce, and protect his rights before a competent and impartial tribunal legally constituted to determine the right involved; representation by counsel; procedure at the hearing consistent with the essentials of a fair trial according to established rules which do not violate fundamental rights, and in conformity to statutes and rules, conducted in such a way that there will be opportunity for a court to determine whether the applicable rules of law and procedure were observed; revelation of the evidence on which a disputed order is based and opportunity to explore that evidence, and a conclusion based on the evidence and reason. * * *" 2 Am.Jur.2d, Administrative Law, § 353, quoted with approval in Katz v. Alabama State Bd. of Medical Examiners, supra.

To like effect is the Court of Civil Appeals' decision in Parducci v. Payne, 360 So.2d 1023 (Ala.Civ.App.1978), where it was held that "one charged with an offense to be tried at an adjudicatory administrative hearing is entitled to procedural due process. Such due process includes adequate notice of the complaint against him and a reasonable opportunity to prepare a defense with assistance of counsel." 360 So.2d at 1024.

It is contended by Medical Services Administration that the following letter comports with an adequate notice of a "fair hearing," viz:

"October 20, 1977

"CERTIFIED MAIL "Mr. Henry Patrick Duke Duke Drug Center 121 North Street Talladega, Alabama 35160 "Dear Mr. Duke:
"I am in receipt of information which substantially reflects apparent abuse of the Alabama Medicaid Program by Duke Drug Center. This information indicates that comparison of numerous original prescriptions and drug drafts submitted *687 by your pharmacy to Medicaid for these prescriptions disclosed that your pharmacy billed Medicaid for drugs other than those dispensed or identified on the prescription. This information further indicates that this abuse resulted in an overcharge to the program for non-valid charges.
"Because of the substantial evidence supporting your abuse of the Medicaid Program, I am offering you a fair hearing to determine whether you should be terminated as a Medicaid provider. The hearing has been scheduled for Wednesday, November 9, 1977, at 1:30 p. m. in the Medical Services Administration Conference Room located in Building 1 at 2500 Fairlane Drive, Montgomery, Alabama. Your failure to respond to this offer of a fair hearing within fourteen days after the date of this letter will indicate that you do not wish a fair hearing, and you will be terminated as an Alabama Medicaid provider without further action.
"If you do accept the offer of a fair hearing, you are expected to be present at the scheduled time. You may have legal representation to assist you, call witnesses in your behalf, and introduce documentary material. You are also permitted to examine material pertinent to the case at the offices of Medical Services Administration between the hours of 8:00 a. m. and 5:00 p. m. and/or at the time of the hearing.
"If you indicate your desire for a fair hearing, the hearing officer will prepare a written report of the proceedings to include his findings and recommendation. I will use this record in reaching a decision. You will receive written notification of my decision on the action to be taken.

"Regards, "Jack E. Worthington (signature) "Jack E. Worthington, Commissioner "Medical Assistance "JEW:STH:kt "cc: Sam T. Hardin, R. Ph."

We cannot agree that this letter constitutes adequate notice of a "fair hearing," a concomitant of "procedural due process."

The evidence shows that Duke had issued some 15,000 Medicaid prescriptions in the two fiscal years 1976 and 1977. According to the testimony, Medical Services Administration had examined and reviewed approximately 180 prescriptions and determined that some 170 were "extremely suspect." Of these latter, approximately 10 or 15 were "selected" for presentation at the fair hearing.

Surely, at a minimum, notice of a "fair hearing" should have accorded this plaintiff some indication of the specific prescriptions, dates, and amounts, which Medical Services Administration contended constituted Medicaid fraud or double billing. Even the hearing examiner Mr. Robert Crumpler stated, just prior to beginning the examination of the first witness, "I really don't know what you are charged with either. . . Mr. Duke . . . ."

In State v. Becker, 326 Mo. 1193, 34 S.W.2d 27 (1930) the Missouri Commission of Securities sought a hearing to revoke Becker's securities license. In prohibiting the hearing because of lack of "reasonable notice," the Missouri Supreme Court held, viz:

"The notice is a double-barreled effort. It orders the production of books and papers and orders relators to show cause why their licenses should not be revoked under section 23 for causes named in paragraphs 1, 3, and 5 of said section. It contains no charges, and the commissioner did not furnish such information. How could they show cause without official information as to the charges? A hearing presupposes the existence of charges. There could be no hearing without charges. Therefore, it seems clear that the Legislature intended `reasonable notice' to include information as to the charges.

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