Vizion One, Inc. v. District of Columbia Department of Health Care Finance

170 A.3d 781
CourtDistrict of Columbia Court of Appeals
DecidedOctober 5, 2017
Docket14-AA-1023; 14-AA-1024
StatusPublished
Cited by6 cases

This text of 170 A.3d 781 (Vizion One, Inc. v. District of Columbia Department of Health Care Finance) is published on Counsel Stack Legal Research, covering District of Columbia Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Vizion One, Inc. v. District of Columbia Department of Health Care Finance, 170 A.3d 781 (D.C. 2017).

Opinion

Reid, Senior Judge:

In these consolidated appeals petitioner, Vizion One, Incorporated (“Vizion One”), challenges decisions of an Administrative Law Judge (“ALJ”) of the Office of Administrative Hearings (“OAH”). The decisions concerned actions taken against Vi-zion One by respondent, D.C. Department of Health Care Finance (“DHCF”), The first decision (Appeal No. 14-AA-1023) involved DHCF’s suspension of Medicaid payments to Vizion One based on a “credible -allegation of fraud”; Vizion One appealed that decision to OAH but the ALJ dismissed- the appeal on the ground that it was untimely. The second decision (Appeal No. 14-AA-1024) concerned DHCF’s “termination for convenience” of Vizion One’s Medicaid Provider Agreement. The ALJ (1) rejected Vizion One’s arguments that DHCF had terminated the provider agreement in bad faith and had violated Vizion One’s due process rights, and (2) granted DHCF’s cross-motion for summary adjudication and dismissed the case with prejudice. For the reasons stated below we affirm OAH’s decision in Appeal No. 14-AA-1024, but we vacate OAH’s decision dismissing Appeal No. I4-AA-1023 and remand that case to OAH for further proceedings, including an evidentiary hearing, on the merits of Vizion One’s appeal.

PART ONE: APPEAL NO. 14-AA-1023: DHCF’S TEMPORARY SUSPENSION OF VIZION ONE’S MEDICAID PAYMENTS

I. FACTUAL SUMMARY

A. DHCF’s Letter of February 20, 2014, Vizion One’s Response, and DHCF’s Reply of March 26, 2014.

The record reveals the following. On February 21, 2014, DHCF hand delivered a letter, dated February 20, 2014, to Vizion One. The letter stated that DHCF “was informed that the owner, operator, or employee(s) of Vizion One [ ] ha[d] been arrested for health care fraud,” and that this information constituted “a credible allegation of fraud for which an investigation is pending under the Medicaid program.” 1 Hence, under 42. C.F.R. § 455.23(a), DHCF was “withholding all Medicaid payments due to [Vizion One] as a provider of home health services .under the District [of Columbia’s] Medicaid program.” 2 The payments were suspended, effective February 20, 2014. DHCF stated that “[i]n addition to [its] right to request administrative review by DHCF, [Vizion One] ha[d] the right to appeal [the suspension] decision by filing a written request with [OAH] .... for a hearing before an [ALJ] within fifteen (15) calendar days of receipt of this notice.” 3 The letter makes no mention of a “good cause” determination under 42 C.F.R. § 455.23(a)(1) (2012).

At the time when Vizion One was notified that its Medicaid payments were suspended, it operated a. multimillion dollar business with 1100-1200 clients, and over 1,000 personal care aides, nurses, and other staff. The federal regulation under which'DHCF suspended payment to Vizion One specified that (1) “[t]he State Medicaid agency' must suspend all Medicaid payments to a provider after the agency determines there is a credible allegation of fraud ... unless the agency has good cause to not suspend payments or to suspend payment only in part[,]” (42 C.F.R. § 455.23(a)(1)); (2) “[a] provider may request, and must be granted administrative review where State [including the District of Columbia] law so requires!!,]” § 455.23(a)(3); and (3) the notice of suspension must “[s]et forth the applicable State administrative appeals process and corresponding citations to State law[,]” § 455.23(b)(2)(vi). While the letter informed Vizion One that it had the right to request an administrative review “within five (5) days of th[e] notice” and “the right to appeal this decision by filing a written request with the District of Columbia Office of Administrative Hearings” “within fifteen (15) calendar days of receipt of this notice, it was silent as to the District’s “good cause” determination, the appeals process, and contained no citations to District law regarding the appeals process.

Vizion One timely invoked its right to an administrative review by submitting a written letter by email to DHCF on February 25, 2014. The letter asserted Vizion One’s difficulty in preparing a response because DHCF had “seized” “virtually [Vi-zion One’s] entire set of records.” Vizion One declared that “no owner or management employee ... há[d] been arrested for, or charged with, health care fraud[,]” but that “one or more lower level former or current employees ha[d] been charged with colluding with several patients to defraud the Medicaid program, and [ ] [they] were arrested.” The rest of the response set forth Vizion One’s arguments and evidence for lifting the suspension, based on the “good cause” exception in 42 C.F.R. § 455.23(a)(1), including the negative impact on Vizion One’s ability to service its 1100 to 1200 clients and meet its $900,000 per week payroll.

About one month later, DHCF sent Vi-zion One another letter, dated March 26, 2014, responding to Vizion One’s “letter dated February 25, 2014[,] regarding DHCF’s decision to suspend Medicaid payments to. Vizion One[].” DHCF addressed the letter to attorneys at yizion One’s first law firm; a “certificate of mailing” appears to be postmarked March 31, 2014. The March 26 letter stated that “an employee of Vizion One [ ]” had been arrested and indicted on charges of “conspiracy to commit health care fraud in a scheme to defraud DC Medicaid out of more than $124,000,” and that the indictment and seizure of Vizion One’s, records was “sufficient to meet the CFR standard for a credible allegation of fraud.” The letter further stated: “We have reviewed your response to our notice of suspension of payments to Vizion One, Inc. and we have considered the good cause exception and whether to suspend payment in part and our position has not changed.” DHCF declared that Vizion One’s suspension would continue “until further notice.” The letter advised Vizion One of its “right to request an appeal of [DCHF’s] decision by filing a written request within fifteen days of this notice with [OAH].” The letter again contained no citations to District law regarding the appeals process.

B. Vizion One’s Appeal to OAH

In response to the March 26, 2014,’ letter,' the attorney representing Vizion One at the time sent a letter on April 10, 2014, to DHCF appealing the temporary suspension. The certificate of service attached to the attorney’s letter indicates it was sent by mail to DHCF. A five-page fax (including cover, the attorney’s letter, and a copy of DHCF’s March 26, 2014, letter) was sent to OAH, also on April 10; the fax contained a time stamp of 5:19 p.m. An email stating, in part, that “[a] fax has arrived,” was sent from a dcnet.efaxl@dc. gov address to OAH at 6:29- p.m. on April 10, 2014. OAH stamped the email as received on April 11,2014, at 9:05 a.m.

On Friday May 30, 2014, Vizion One electronically filed a Motion for Summary Adjudication.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Bloomberg, Inc. v. District of Columbia Office of Tax & Revenue
District of Columbia Court of Appeals, 2026
District of Columbia Metropolitan Police Department v. Porter
District of Columbia Court of Appeals, 2025
In re Kittrie Sobel
District of Columbia Court of Appeals, 2024
Yazam v. D.C. Department of For-Hire Vehicles
District of Columbia Court of Appeals, 2024
Booz Allen Hamilton v. D.C. Office of Tax and Revenue
District of Columbia Court of Appeals, 2024
Aldray Reed v. Florine Rowe
195 A.3d 1199 (District of Columbia Court of Appeals, 2018)
Donna Black v. DC Dept. of Human Servs.
188 A.3d 840 (District of Columbia Court of Appeals, 2018)

Cite This Page — Counsel Stack

Bluebook (online)
170 A.3d 781, Counsel Stack Legal Research, https://law.counselstack.com/opinion/vizion-one-inc-v-district-of-columbia-department-of-health-care-finance-dc-2017.