Signature Health Center, LLC v. State

92 A.D.3d 11, 935 N.Y.2d 357
CourtAppellate Division of the Supreme Court of the State of New York
DecidedDecember 15, 2011
StatusPublished
Cited by19 cases

This text of 92 A.D.3d 11 (Signature Health Center, LLC v. State) 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
Signature Health Center, LLC v. State, 92 A.D.3d 11, 935 N.Y.2d 357 (N.Y. Ct. App. 2011).

Opinion

OPINION OF THE COURT

Peters, J.P.

In 1999, claimant was approved by the Department of Health (hereinafter DOH) to operate as a licensed diagnostic and treatment center and thereafter provided services to Medicaid recipients under defendant’s Medicaid program. As a newly approved provider without cost experience, claimant initially received a “budgeted” rate of reimbursement per threshold patient visit based on its projected costs. Pursuant to DOH regulations, this rate was subject to a retroactive adjustment based upon actual costs incurred during the first full fiscal year of operation (see 10 NYCRR 86-4.19 [b]). In 2001, claimant submitted a cost report to DOH for the 2000 calendar year and sought an adjustment of its rate. After the cost report was reviewed, endorsed and approved by DOH, a new threshold rate was calculated, which was approximately $35 per threshold visit higher than the initial budgeted rate. This new rate was then certified by the Division of Budget in December 2001. In May 2002, claimant sought a further rate adjustment based upon a revised cost report for 2000, which was thereafter approved by DOH and certified by the Division of Budget in December 2002. However, DOH did not publish the revised rates and refused to reimburse claimant in accordance with them.

Claimant thereafter commenced a CPLR article 78 proceeding seeking to compel DOH to publish the revised reimbursement rates and to release the payments owed to it. Supreme Court (Sheridan, J.) found that, inasmuch as the new rates had been approved and certified, the posting of such rates was a ministerial act required to be performed by law. Upon the court’s order that DOH publish the revised reimbursement rates and make [13]*13all payments due to claimant in accordance with those rates, DOH paid approximately $3 million in retroactive reimbursement.

Claimant then commenced this action against defendant seeking consequential damages, including lost profits, arising from defendant’s delay in publishing and paying the revised reimbursement rates. The Court of Claims granted claimant’s motion for summary judgment on the issue of liability, finding that the judgment in the CPLR article 78 proceeding collaterally estopped defendant from relitigating the issue of ministerial negligence (see Signature Health Ctr., LLC v State of New York, 23 Misc 3d 1103[A], 2009 NY Slip Op 50559[U] [2009]). Following a trial on damages, the court directed the parties to brief the impact of the Court of Appeals’ recent decisions in McLean v City of New York (12 NY3d 194 [2009]) and Dinardo v City of New York (13 NY3d 872 [2009]), which clarified and arguably changed the law with respect to governmental immunity for ministerial and discretionary actions. Finding that the law as set forth in McLean and Dinardo differed from that which it applied in previously deciding the issue of liability, the Court of Claims reexamined the issue of liability in light of those decisions and concluded that defendant could not be liable for failure to perform a ministerial action unless it owed a special duty to claimant and that, under these circumstances, a special duty existed because Public Health Law § 2807 implicitly created a private cause of action for the benefit of Medicaid treatment providers. On the issue of damages, however, the court found that claimant failed to prove that its alleged lost profits resulted directly from the delayed reimbursement, and denied the additional claims for consequential damages based upon a failure of proof. Claimant appeals.

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Bluebook (online)
92 A.D.3d 11, 935 N.Y.2d 357, Counsel Stack Legal Research, https://law.counselstack.com/opinion/signature-health-center-llc-v-state-nyappdiv-2011.