Spano v. Novello

2 Misc. 3d 864, 772 N.Y.S.2d 215, 2003 N.Y. Misc. LEXIS 1694
CourtNew York Supreme Court
DecidedOctober 14, 2003
StatusPublished
Cited by1 cases

This text of 2 Misc. 3d 864 (Spano v. Novello) 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
Spano v. Novello, 2 Misc. 3d 864, 772 N.Y.S.2d 215, 2003 N.Y. Misc. LEXIS 1694 (N.Y. Super. Ct. 2003).

Opinion

OPINION OF THE COURT

John G. Connor, J.

Petitioners seek by order to show cause an order and judgment declaring respondents’ demand seeking $7,304,980.44 in [865]*865Medicaid reimbursement for psychiatric care provided to Medicaid recipients between 1984 and 1992 to be an error of law, arbitrary and capricious. Petitioners also seek a preliminary injunction enjoining the respondents from taking possession of $7.3 million of Westchester County’s funds. In addition, petitioners seek by motion to join St. Vincent’s Catholic Medical Centers of New York and New York-Presbyterian Hospital as parties to this action and to convert this CPLR article 78 proceeding into an action seeking both declaratory, injunctive and monetary relief.

Respondents oppose the application and the motion and allege the respondents Comptroller Hevesi and Commissioner Stone are not proper parties to this proceeding, the demand from the Department of Health was rational, the demand letter of January 14, 2003 to the County of Westchester was not untimely and not barred by laches. The respondents also alleged the petitioners are not entitled to a preliminary injunction.

The State of New York participates in the federal Medicaid program which provides financial assistance to states for necessary medical care provided to indigent persons (see, 42 USC § 1396 et seq.). Generally, the federal program pays the State approximately 50% for Medicaid expenditures. The New York State Department of Health (NYSDOH or Department) calculates the County’s share of the expenditures after reimbursement from federal and state funds.

For a hospital to be certified as a Medicaid provider it must meet specific conditions of participation (see, 42 USC § 1395cc). The hospital must be licensed by the New York State Department of Health and the State is responsible for determining if the hospital meets the required criteria. If a hospital provides psychiatric treatment to patients it must be licensed by either the NYSDOH or the New York State Office of Mental Health (NYSOMH).

If a general hospital contains psychiatric units they are licensed by NYSDOH pursuant to Public Health Law article 28 and by NYSOMH pursuant to Mental Hygiene Law § 31.04 (a) (4). Private freestanding psychiatric hospitals are licensed by NYSOMH pursuant to Mental Hygiene Law article 31.

If an institution seeks certification as a psychiatric hospital by the State of New York, federal regulations require that such hospital be “primarily engaged in providing . . . psychiatric services for the diagnosis and treatment of mentally ill persons” [866]*866(42 CFR 482.60). The Medicaid statute specifically excludes patient care at an institution for mental diseases. A certification of a facility as a “psychiatric hospital” disqualifies an institution from Medicaid reimbursement (see, 42 USC § 1396d). From its inception, the Medicaid Act excludes reimbursement for services provided to patients at any institution for mental diseases (IMD) (see, 42 USC § 1396d [a] [1]; [i]; 42 CFR 435.1008 [a] [2]; 441.13 [a] [2]). IMD is defined in the statute as “a hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care and related services” (42 USC § 1396d [i]).

St. Vincent’s Hospital and Medical Center in Westchester County, New York (St. Vincent’s), was certified by the State as a psychiatric hospital on June 23, 1966 until 1992. In 1992, St. Vincent’s was recertified by the State as a psychiatric unit of St. Vincent’s Hospital and Medical Center in New York City.

New York Hospital Westchester Division (New York Hospital) was certified by the State as a psychiatric hospital from 1966 through 1990. On January 1, 1991, New York Hospital was recertified by the State as a psychiatric unit of New York Hospital-Cornell Medical Center in New York City.

In a letter dated January 14, 2003 the NYSDOH advised the County that in the early 1990’s the federal government disallowed the State’s claim for federal Medicaid reimbursement for psychiatric care provided to residents between 1984 and 1992. After a federal audit, the State was notified that the Medicaid reimbursement disallowances amounted to $38 million. After years of litigation and appeals, the federal government and the State attained a settlement whereby the agreed upon disallowances totaled $32,591,732. The letter informed the County that the State sought payment of $7,304,980.44 because of “two disallowances in the early 1990’s of the State’s claims for federal Medicaid reimbursement for psychiatric care provided to Medicaid recipients.” The County subsequently learned that the disallowances were attributable to the costs of psychiatric care provided to persons at St. Vincent’s and New York Hospital for the years 1984-1991. After a review of the disallowances and the allocation methodology utilized to calculate the amount due, the State reduced its demand to $6,939,333.80. The State seeks immediate reimbursement from the County for the full amount allegedly due utilizing the State’s electronic funds transfer method.

[867]*867The County alleges it first received notice of the results of the federal Medicaid audit in 2003. The County claims that this was the first time they had learned of the federal audit, the disallowance litigation commenced in 1995, the memorandum opinion of the federal court issued on September 17, 1997 and the settlement agreement entered into May 28, 1998. The County contends that it has been 19 years since unspecified services were rendered to patients in freestanding psychiatric hospitals and more than five years after the disallowances were settled between the federal government and the State.

The County contends the State failed to provide any substantive information regarding the calculation of charges from the two psychiatric hospitals; failed to demonstrate how it assessed the costs against the County; failed to provide detailed facts of services provided for the 19-year period; failed to demonstrate how many of the Medicaid patients in the two hospitals were residents of Westchester County; and the State failed to seek reimbursement from the medical providers — St. Vincent’s and New York Hospital. The County claims that their records do not go back as far as 1984 and no records exist for the time period in question. The County alleges that, for the period of 1993-2000, the average percentage of Westchester County residents receiving assistance from either of the two hospitals ranged from 23.6% to 72.4%. The County alleges that the State erroneously required the County to fund Medicare expenses for services rendered at the two hospitals when they were specifically excluded from the Medicaid program costing the County approximately $8.9 million in Medicaid contributions over the years.

NYSDOH alleges that St. Vincent’s and New York Hospital were certified by the Department as freestanding psychiatric facilities and were institutions for mental diseases. The State acknowledges that the costs of the health care services are not eligible for federal Medicaid reimbursement for individuals residing in IMDs who are between the ages of 21 and 64.

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Related

Matter of Spano v. Novello
2003 NY Slip Op 23969 (New York Supreme Court, Albany County, 2003)

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Bluebook (online)
2 Misc. 3d 864, 772 N.Y.S.2d 215, 2003 N.Y. Misc. LEXIS 1694, Counsel Stack Legal Research, https://law.counselstack.com/opinion/spano-v-novello-nysupct-2003.