State v. Farragut Nursing Home

116 Misc. 2d 437, 455 N.Y.S.2d 336, 1982 N.Y. Misc. LEXIS 3897
CourtNew York Supreme Court
DecidedOctober 25, 1982
StatusPublished
Cited by5 cases

This text of 116 Misc. 2d 437 (State v. Farragut Nursing Home) 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
State v. Farragut Nursing Home, 116 Misc. 2d 437, 455 N.Y.S.2d 336, 1982 N.Y. Misc. LEXIS 3897 (N.Y. Super. Ct. 1982).

Opinion

OPINION OF THE COURT

Frank Composto, J.

In this action by the State to recoup funds paid to defendants, operators of a health care facility (Farragut Nursing Home) pursuant to a rate of reimbursement established provisionally and subject to later audit for adjustment, the State moves for summary judgment and to strike out the answers of the defendants Farragut Nursing Home, a partnership (Farragut) and of the partners, Herbert Tuckman (Tuckman) and Esther Ostreicher (Ostreicher).

It is undisputed that for the years 1972, 1973 and 1974 defendant Farragut, a licensed health care facility, furnished services to indigent patients in the Medicaid pro[438]*438gram established by Congress, and administered by each State with its own funds as supplemented by Federal grants. A provisional rate of reimbursement is established for each health care facility based on its estimated costs and expenditures. This rate is subject to later change after an audit is made of the books and records of the facility. An audit was made by plaintiff and defendants were duly notified by letter dated November 23, 1976 that the “audit of your financial cost report for the years ending 1972-4 * * * was completed * * *, disclosed the adjustments which are detailed on the attached schedule. These adjustments are final unless we receive a written protest within 30 days from receipt of this letter. Such request must be in writing detailing each adjustment disputed and setting forth the reimbursement principle or basis for disputing each item”.

The notice of audit was answered by Litt & Prager (L & P), certified public accountants on behalf of Farragut stating “we wish to appeal the audit findings”. Upon request, L & P had Farragut formally advise plaintiff “that the firm of litt & prager has been designated by us to act as our representatives in the appeal”. The notice of retainer of L & P was signed by Ostreicher on behalf of Farragut. Defendant Tuckman individually retained the law firm of Gluck, Romano & Tuckman (M. Tuckman) to represent him on the audit appeal. Thus, all defendants were represented on the appeal and all defendants agreed either by their conduct of the appeal or expressly in writing, that “It was acceptable * * * that the manner of adjusting this appeal be one of correspondence rather than personal appearance so that the time and energy of all of the various parties expended in this matter would be minimized”. No bureau review in Albany was requested. Each defendant submitted without restrictions the proof each believed to be most cogently responsive and all defendants were given more than ample time to submit their proof. Where defendant stated that judgments of the union were not readily available, plaintiff co-operatively agreed to accept a “notarized statement confirming the amounts currently due to the union”.

On a review of all the proof submitted by the defendants a determination was made “Based on the data presented, [439]*439the 1972 Audit Adjustment should be held. Since HIM-15 is specific about payments to the Pension Fund, no unpaid costs can be allowed; therefore, only the amounts the Welfare and Dental Fund should be allowed for 1973 and 1974”, a partial recognition of defendants’ appeal. The final determination that the appeals “completed by the Bureau of Audit Appeals in accordance with Part 86-2.7(e) of the Commissioner’s Rules and Regulations” were sent to the respective representatives of the defendants and to the defendants individually. Neither representative, M. Tuck-man, nor L & P denied receiving the determinations and none of the defendants either requested or commenced any further proceedings to review the final determination. Formal objections thereto were raised for the first time in this action.

The foregoing statement of facts constitutes this court’s findings and are based on the papers and exhibits before the court.

For facility and clarity of determination of the issues presented on this motion, the court, initially and in sequence will consider the defendants’ defenses and counterclaims.

Although no formal answer has been interposed on behalf of the partnership, Farragut, nevertheless the court will consider the evidence in opposition to the original motion for summary judgment as the answer of said defendant.

In each of the formal answers of the individual defendants, the Statute of Limitations is pleaded as a bar to plaintiff’s action in recoupment of overpayments made to Farragut. The defendants structure their respective positions on the lapse of time commencing from the reimbursement payments made to Farragut. But neither defendant considers nor recognizes that those payments were made “on the initial submission of base year data and reports * * * [and must] be construed to represent a provisional rate until such audit is performed and completed, at which time such rate or adjusted rate will be construed to represent the audited rate” (10 NYCRR 86-2.7 [a]; emphasis added.) Thus, no cause of action on behalf of the State commenced [440]*440to accrue on the provisional payments that were paid. Neither the State nor the health facility recipient construed those payments as firm and fixed amounts due and payable to the health facility. This ineluctable conclusion becomes evident from a reading of 10 NYCRR Subpart 86-2.

Section 86-2.2, captioned “Financial and statistical data required”, commands in subdivision (a) “Each residential health care facility * * * [to] complete and file * * * annual financial and statistical report forms * * * [and] must report their operations * * * on a calendar-year basis.” Subdivision (b) then states that “Federal regulations require the submission of cost reports to the State agency no later than three months after the close of the cost reporting year.” Subdivision (c) then provides for a 2% penalty reduction in the current rate “In the event a residential health care facility fails to file the required financial and statistical reports”. Section 86-2.3 mandates, as captioned, “Uniform system of accounting and reporting” and 10 NYCRR 86-2.4, 2.5 and 2.6 provide that the reports shall be in accordance with generally accepted accounting principles certified by an independent licensed public accountant and by the operator or officer of the facility.

Until those reports are filed there can be no determination on whether any part of the payments made to the facility constitute overpayments nor does any obligation arise to make refund. Schematically, 10 NYCRR 86-2.7 provides for “Audits”. Subdivision (a) thereof declares that “All fiscal and statistical records and reports shall be subject to audit” and requires the facility to keep and maintain all of its “books, records and documentation * * * for a period of time not less than six years from the date of filing, or the date upon which the fiscal and statistical records were to be filed, whichever is the later date”. Subdivision (b) directs the State agency to conduct “field audits * * * of the records of residential health care facilities”. On completion of the audit the facility is accorded the right of conference and may appear in person or by its representative (10 NYCRR 86-2.7 [d]). A copy of the audit report must then, as in the instant case, be furnished to the facility and “The audit report shall be final unless within [441]*44130 days of receipt of the audit report, the residential health care facility initiates [as in the instant action] a bureau review” (10 NYCRR 86-2.7 [e]).

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99 A.D.2d 776 (Appellate Division of the Supreme Court of New York, 1984)

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Bluebook (online)
116 Misc. 2d 437, 455 N.Y.S.2d 336, 1982 N.Y. Misc. LEXIS 3897, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-v-farragut-nursing-home-nysupct-1982.