Ramanadhan v. Wing

174 Misc. 2d 11, 662 N.Y.S.2d 393, 1997 N.Y. Misc. LEXIS 374
CourtNew York Supreme Court
DecidedAugust 12, 1997
StatusPublished

This text of 174 Misc. 2d 11 (Ramanadhan v. Wing) 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
Ramanadhan v. Wing, 174 Misc. 2d 11, 662 N.Y.S.2d 393, 1997 N.Y. Misc. LEXIS 374 (N.Y. Super. Ct. 1997).

Opinion

OPINION OF THE COURT

Beverly S. Cohen, J.

In this CPLR article 78 proceeding, the petitioner, a medical doctor, challenges on constitutional grounds a determination of the New York State Department of Social Services (the Department) dated November 26, 1996 (the Determination). The Determination imposed a fine of $102,000 and suspended the doctor from participating in the New York State Medicaid Provider Program (Medicaid). This action was taken without a hearing. Petitioner also asks for injunctive relief barring the Department from suspending her from participation prior to the hearing, or staying her exclusion from Medicaid. Petitioner also argues that the Determination is arbitrary and capricious and the penalty imposed is so disproportionate to the offense as to shock the conscience.

The Department opposes the petition on the grounds that the doctor has failed to exhaust administrative remedies and that the regulations pursuant to which the doctor was suspended have been approved by the courts. The petition is granted in part and denied in part for the reasons that follow. The motion for injunctive relief is granted.

Petitioner is a pediatrician practicing in a clinic in the In-wood section of upper Manhattan, where there is a shortage of doctors. Her patient population is comprised of poor children and their adult parents and caretakers, 100% of whom are insured by Medicaid. Petitioner’s husband operates a pharmacy across the street from the clinic.

[13]*13On November 9, 1995, the Department issued a notice of proposed agency action stating that petitioner had engaged in unacceptable practices as defined in 18 NYCRR 515.2. Specifically, petitioner was charged with providing and submitting claims for medical services and prescriptions that were false, not medically necessary, and not supported by adequate records documenting their necessity.

Petitioner was given an opportunity to refute the charges in writing, and did so on December 20, 1995.

On November 26, 1996, the Department issued the Determination. Petitioner’s contract with Medicaid was terminated and she was excluded from Medicaid for three years effective on December 19, 1996. The effective date of her exclusion was extended until December 25, 1996. The Determination advised petitioner that she could request a special administrative hearing.

Petitioner requested a hearing by letter dated December 5, 1996. On the return date of the petition herein, January 16, 1997, this court granted a temporary restraining order staying respondent from excluding petitioner from Medicaid pending determination of this petition. On January 21,1997, petitioner’s name was published by respondent on a list of providers excluded from Medicaid. Her name was subsequently removed from the list on a date that does not appear in the record.

The hearing originally was scheduled for March 6, 1997, but the parties advised the court that it was adjourned to April 29, 1997, four months after the effective date of petitioner’s suspension. The reason for the adjournment was that one of the Department’s witnesses was unavailable. Petitioner agreed to the adjournment because of the stay granted by this court. The parties have advised the court that two more adjournments were granted. The second adjournment was granted to May 15, 1997 because petitioner was ill. On May 15, 1997, one day of testimony was taken. The hearing was then adjourned for three months until August 14, 1997.

After the date of submission, the court gave the parties an opportunity to submit additional information. The court requested that the parties advise the court in writing of the reason for the adjournment of the hearing. The court also asked the parties by letter to specify what rules and regulations supported petitioner’s contentions concerning the consequences of exclusion from Medicaid.

The exclusion of a doctor from the Medicaid program for misconduct produces grave professional consequences. The [14]*14Federal Government requires that all State Medicaid programs contain a provision that the State will provide information and access respecting sanctions taken against doctors by Medicaid to the State licensing authority, any peer review organizations, any private accreditation entity, and to the agencies administering Federal health care programs. (42 USC § 1396r-2 [a] [1], [2]; 42 CFR 455.17.) When Medicaid initiates the exclusion of a doctor, it is required to notify other State agencies, the State medical licensing board, the public, beneficiaries, and everyone entitled to notice of an exclusion from Medicaid pursuant to 42 CFR 1001.2005 and 1001.2006. (42 CFR 1002.212.) An exclusion from Medicaid requires reporting of the facts and circumstances of the exclusion to the appropriate State or local agencies responsible for licensing and certification of doctors (42 CFR 1001.2005), and notice of the exclusion "as appropriate” to:

"(1) Any entity in which the excluded individual * * * is known to be serving as an employee, administrator, operator, or in which the individual or entity is serving in any other capacity and is receiving payment for providing services * * *
"(2) State Medicaid Fraud Control Units;
"(3) Utilization and Quality Control Peer Review Organizations;
"(4) Hospitals, skilled nursing facilities, home health agencies and health maintenance organizations;
"(5) Medical societies and other professional organizations;
"(6) Contractors, health care prepayment plans, private insurance companies and other affected agencies and organizations;
"(7) The State and Area Agencies on Aging established under title III of the Older Americans Act; and
"(8) Other Departmental operating divisions, Federal agencies, and other agencies or organizations, as appropriate.” (42 CFR 1001.2006.)

Exclusion from Medicaid is a ground for which proceedings may be commenced to exclude the doctor from Medicare. (42 USC § 1320a-7 [b] [5]; 42 CFR 1001.601.)

The petitioner has submitted evidence demonstrating that the MetLife Empire Plan automatically terminates contracts with physicians who have been excluded by Medicaid.

Once a doctor is excluded from Medicaid a hospital cannot be reimbursed by Medicaid for any services or medicines ordered by the excluded doctor, with the exception of a 30-day [15]*15period in which the doctor may continue to treat patients admitted prior to the exclusion. (18 NYCRR 515.5.)

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Bluebook (online)
174 Misc. 2d 11, 662 N.Y.S.2d 393, 1997 N.Y. Misc. LEXIS 374, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ramanadhan-v-wing-nysupct-1997.