NYS CLINICAL LAB. v. Kaladjian

649 N.E.2d 811, 85 N.Y.2d 346, 625 N.Y.S.2d 463
CourtNew York Court of Appeals
DecidedFebruary 23, 1995
StatusPublished
Cited by1 cases

This text of 649 N.E.2d 811 (NYS CLINICAL LAB. v. Kaladjian) is published on Counsel Stack Legal Research, covering New York Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
NYS CLINICAL LAB. v. Kaladjian, 649 N.E.2d 811, 85 N.Y.2d 346, 625 N.Y.S.2d 463 (N.Y. 1995).

Opinion

85 N.Y.2d 346 (1995)
649 N.E.2d 811
625 N.Y.S.2d 463

In the Matter of New York State Clinical Laboratory Association, Inc., Appellant,
v.
Gregory Kaladjian, as Acting Commissioner of Social Services of the State of New York, Respondent.

Court of Appeals of the State of New York.

Argued January 5, 1995
Decided February 23, 1995.

Harter, Secrest & Emery, Rochester (Thomas G. Smith of counsel), for appellant.

Dennis C. Vacco, Attorney-General, Albany (Daniel Smirlock, Jerry Boone and Peter H. Schiff of counsel), for respondent.

Chief Judge KAYE and Judges SIMONS, TITONE, BELLACOSA, SMITH and LEVINE concur.

*349CIPARICK, J.

The issue presented on this appeal is whether a partially prevailing petitioner may recover attorney's fees from the State pursuant to CPLR article 86, the Equal Access to Justice Act (State EAJA). This petitioner is not entitled to a fee award because it is not a "prevailing party" within the meaning of the State EAJA and the State's position in this litigation was substantially justified.

In October 1991, respondent Department of Social Services amended 18 NYCRR 505.7, changing the Medicaid payment methodology for certain diagnostic laboratory tests performed by independent laboratories. 18 NYCRR 505.7 (g) (4) provides:

"Payment for laboratory services provided by independent laboratories will be made only for individually ordered tests. No payment will be made for tests ordered as groupings or combinations of tests or for individual tests ordered on a laboratory order form issued by an independent laboratory which also contains an order for one or more groups or combinations of tests. Each test must be separately ordered by a qualified practitioner as defined in paragraph (b) (3) of this section."

*350Prior to the amendment, independent laboratories were entitled to receive payment for tests ordered by physicians on preprinted laboratory requisition forms containing "panels" or "profiles." Panels are groups of tests conducted on a single specimen, and profiles are groups of tests performed for the purpose of assessing the function of a particular body organ or tissue. Although laboratory tests could be ordered singularly, the practice of ordering entire groups of tests in panels and profiles had become widespread, leading respondent to conduct an investigation which revealed that laboratories were creating panels and profiles, some of which included as many as 15 tests, that physicians were ordering out of convenience rather than medical necessity. In an effort to curb this wasteful practice, which inured to the benefit of independent laboratories at taxpayer expense, respondent amended 18 NYCRR 505.7.

Petitioner, an association of independent laboratories, and an opponent of the amendment throughout the promulgation process, requested an interpretation of the amendment prior to its implementation, submitting the following question:

"1. May tests be ordered informally by grouping them together under a profile heading so long as each component test is individually ordered?"

Respondent answered the question by stating that American Medical Association-approved testing categories would be considered acceptable as "headers" on preprinted order forms; however, all tests included in such categories would have to be individually ordered for reimbursement purposes.

Petitioner commenced this CPLR article 78 proceeding alleging that the amended regulation lacked a rational basis, violated the Equal Protection Clauses of the State and Federal Constitutions, and was being interpreted by respondent in a manner inconsistent with its plain language. Supreme Court granted the petition to the extent of declaring section 505.7 (g) (4) null and void on the ground that it violated petitioner's equal protection rights. The Court also declared that respondent's interpretation of the amended regulation was arbitrary and capricious. Petitioner was awarded costs, disbursements and attorney's fees pursuant to 42 USC §§ 1983 and 1988.

The Appellate Division modified by reversing so much of Supreme Court's judgment as declared 18 NYCRR 505.7 (g) (4) to be invalid and awarded counsel fees to petitioner. The Appellate Division declared that the challenged regulation *351 "has not been shown to be invalid or unconstitutional" (194 AD2d 189, 194). The appellate Court held that a rational basis existed for the amended regulation, and for distinguishing between independent and hospital laboratories therein: "[T]he regulation's focus on independent laboratories is based upon the proportion they contribute to the problem and it being clear that such is a valid basis for disparate treatment, we discern no equal protection violation" (194 AD2d, at 192 [citations omitted]).

The Court, however, agreed with petitioner that respondent's interpretation of its regulation as permitting the grouping of tests only in categories approved by the AMA was irrational and inconsistent with the plain language of the amended regulation, which "contains no prohibition of any particular grouping on laboratory order forms and, in fact, DSS had stated previously that the amendment would not require any change in the groupings of tests on an order form as long as they were ordered individually" (id., at 193). Finally, the Court concluded that there was no basis for an award of counsel fees pursuant to 42 USC § 1988 because petitioner was denied no constitutional right. Nor was it persuaded under the circumstances that petitioner was entitled to counsel fees pursuant to CPLR article 86 (id.).

I

The State EAJA provides that "a court shall award to a prevailing party, other than the state, fees and other expenses incurred by such party in any civil action brought against the state, unless the court finds that the position of the state was substantially justified or that special circumstances make an award unjust" (CPLR 8601 [a]). The statute was enacted to "improv[e] access to justice for individuals and businesses who may not have the resources to sustain a long legal battle against an agency that is acting without justification" (Governor's Approval Mem, L 1989, ch 770, 1989 NY Legis Ann, at 336). The State EAJA was modeled on the Federal Equal Access to Justice Act (28 USC § 2412 [d] [1] [A]) "and the significant body of case law that has evolved thereunder" (CPLR 8600).

II

Prevailing Party

Petitioner contends that it meets all of the requirements for an award of counsel fees under the State EAJA. Petitioner *352 argues that it is a "prevailing party" within the meaning of the State EAJA because it succeeded in correcting respondent's overbroad interpretation of its own regulation.

Four requirements must be met before a court can award fees to a private litigant under the Federal EAJA: (1) the claimant must demonstrate that it is an eligible party under the statute (see, 28 USC § 2412 [d] [2] [B]); (2) the claimant must be a "prevailing party"; (3) the Government's position must not be "substantially justified"; and (4) there must not exist any special circumstances that would make an award unjust (see, Commissioner, Immigration & Naturalization Serv. v Jean, 496 US 154, 158).

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649 N.E.2d 811, 85 N.Y.2d 346, 625 N.Y.S.2d 463, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nys-clinical-lab-v-kaladjian-ny-1995.