New York Law Review

Tag: Administrative Hearing

  • Visiting Nurse Service of New York Home Care v. New York State Department of Health, 5 N.Y.3d 503 (2005): Entitlement to Hearing Before Medicaid Recoupment

    Visiting Nurse Service of New York Home Care v. New York State Department of Health, 5 N.Y.3d 503 (2005)

    A home health care provider is entitled to notice and an opportunity to be heard before the State acts to recover Medicaid payments it claims were improperly paid when the Department of Health (DOH) regulations provide for such a hearing.

    Summary

    Visiting Nurse Service of New York Home Care (VNS) challenged the New York State Department of Health’s (DOH) recoupment of Medicaid funds, arguing it was not obligated to repay Medicaid unless it received payment from Medicare or another source and that DOH’s procedures lacked an administrative hearing. The court held that DOH’s regulations entitled VNS to a hearing before recoupment. The court reasoned that DOH’s interpretation of “overpayment” to exclude provider liability claims conflicted with the regulation’s plain meaning. The court also found that DOH failed to comply with its own regulatory time frame for conducting hearings, justifying the stay on recoupment pending the hearing.

    Facts

    VNS, a home health care provider, billed Medicaid approximately $1.7 billion for services between October 1993 and September 1998. A review by the Center for Medicare Advocacy (CMA) concluded that $38.2 million should have been reimbursed by Medicare due to dual eligibility. Medicare paid approximately $28.4 million, which VNS refunded to the State. Medicare denied the remaining $10 million in claims due to time elapsed or provider errors, leading to “provider liability” claims. DOH began offsetting these amounts by withholding other Medicaid revenue due to VNS.

    Procedural History

    VNS initiated a CPLR article 78 proceeding challenging DOH’s withholding of Medicaid funds and the lack of an administrative hearing. Supreme Court granted VNS’s petition, holding that VNS had a protected property interest in Medicaid payments requiring a hearing before recoupment. The Appellate Division affirmed, finding VNS entitled to a hearing to determine if reasonable measures were taken to assess Medicare or other third-party eligibility before submitting to Medicaid. The Court of Appeals was certified a question regarding the lower court’s ruling.

    Issue(s)

    Whether a home health care provider is entitled to notice and an opportunity to be heard before the State acts to recover Medicaid payments it claims were improperly paid to the provider.

    Holding

    Yes, because the regulations promulgated by the New York State Department of Health provide that a hearing must be held regarding recoupment of the Medicaid funds in dispute.

    Court’s Reasoning

    The court held that DOH’s regulations, specifically 18 NYCRR 518.5(a), entitled VNS to notice and a hearing before recoupment. The court reasoned that the funds DOH sought to recover fell within the regulation’s broad definition of “overpayment” as “any amount not authorized to be paid under the medical assistance program, whether paid as the result of inaccurate or improper cost reporting, improper claiming, unacceptable practices, fraud, abuse or mistake” (18 NYCRR 518.1 [c]). The court rejected DOH’s argument that “overpayment” excluded provider liability claims, stating that courts are not required to embrace a regulatory construction that conflicts with the plain meaning of the promulgated language, citing Matter of 427 W. 51st St. Owners Corp. v Division of Hous. & Community Renewal, 3 NY3d 337, 342 (2004). The Court emphasized that under 18 NYCRR 518.8(b), DOH’s failure to commence the hearing within 90 days of VNS’s request justified the stay on recoupment. The purpose of the hearing is to determine whether VNS reasonably attempted to ascertain and satisfy the requirements of liable third-party payors, as per 18 NYCRR 540.6(e)(6), which states that recoupment is prohibited only with respect to claims for which VNS acted reasonably in both the initial claim submission and subsequent resubmission efforts. The court noted that the burden will be on VNS to prove it acted reasonably. The court declined to address the federal law preclusion argument raised by VNS because VNS did not cross-move to appeal.

  • সিনসিনাটি v. নিউ ইয়র্ক সিটি ট্রানজিট অথরিটি, 54 N.Y.2d 909 (1981): Due Process and Disciplinary Sanctions in Public Employment

    সিনসিনাটি v. নিউ ইয়র্ক সিটি ট্রানজিট অথরিটি, 54 N.Y.2d 909 (1981)

    A public employee facing disciplinary sanctions is afforded due process when the disciplinary body makes an independent appraisal of the record compiled by a hearing officer, without necessarily requiring a personal hearing before the full board for mitigation of the penalty.

    Summary

    সিনসিনাটি, a high-level supervisor, was discharged by the New York City Transit Authority after a hearing found him guilty of misconduct. সিনসিনাটি appealed, arguing he had a right to personally address the Transit Authority board regarding mitigating the penalty. The New York Court of Appeals affirmed the discharge, holding that due process was satisfied because সিনসিনাটি could present evidence to the hearing examiner, and the Transit Authority made an independent review of the hearing record. There is no absolute right to a personal hearing before the full board.

    Facts

    সিনসিনাটি held a high supervisory position with the New York City Transit Authority. Following a hearing, সিনসিনাটি was found guilty of various charges of misconduct. As a result, the Transit Authority discharged him from his position. সিনসিনাটি did not dispute the finding of misconduct or the severity of the penalty in relation to the charges.

    Procedural History

    Following the administrative hearing and the Transit Authority’s decision to discharge সিনসিনাটি, সিনসিনাটি appealed the decision. The Appellate Division affirmed the Transit Authority’s decision. সিনসিনাটি then appealed to the New York Court of Appeals.

    Issue(s)

    Whether a public employee is vested with a due process right to be heard personally by the board of the transit authority on the question of mitigation of a disciplinary penalty, when that employee was permitted to introduce evidence on the issue before a hearing examiner and the board independently reviewed the hearing record.

    Holding

    No, because as long as the body charged with imposing disciplinary sanctions makes an independent appraisal of the entire record compiled by its duly appointed hearing officer, a public employee has received all that the due process clause demands.

    Court’s Reasoning

    The Court of Appeals reasoned that the requirements of due process are satisfied when a public employee is allowed to present evidence relevant to their case before a hearing examiner, and the disciplinary body (here, the Transit Authority) independently reviews the record from that hearing. The court emphasized that সিনসিনাটি was permitted to introduce any and all evidence deemed relevant before the hearing examiner. The court cited precedent, including Matter of Simpson v. Wolansky, to support the principle that due process requires only an independent appraisal of the record by the disciplinary body. The court found that no further process was due, and explicitly held that there is no right to a personal hearing before the full board for mitigation purposes as long as the record was independently reviewed. The court also cited Mildner v. Gulotta, noting the US Supreme Court’s affirmation of that case, further bolstering its conclusion that due process was satisfied in this instance.

  • Matter of Bonacorsa v. Koch, 64 N.Y.2d 860 (1985): Termination of Probationary Employee & Due Process

    Matter of Bonacorsa v. Koch, 64 N.Y.2d 860 (1985)

    A probationary employee is not entitled to an administrative hearing concerning the reasons for dismissal unless they demonstrate the dismissal was for an improper reason or in bad faith.

    Summary

    Bonacorsa, a probationary police officer, was terminated without a hearing by the police commissioner. He sought annulment of the determination and reinstatement, arguing his dismissal was improper. The court held that, absent proof of improper reason or bad faith, a probationary employee is not entitled to a hearing prior to termination. The court found the dismissal was rationally based on Bonacorsa’s prior involvement with organized crime, which he did not disclose upon joining the police department, and was therefore neither arbitrary nor capricious. The court explicitly declined to address constitutional arguments raised by the petitioner because they were not presented in the original prayer for relief.

    Facts

    Bonacorsa was a probationary police officer. Prior to joining the police department, he had involvement with organized crime, allegedly through undercover work. He did not disclose these contacts when he joined the police force. The police commissioner terminated Bonacorsa’s employment without a hearing.

    Procedural History

    Bonacorsa sought an annulment of the police commissioner’s determination and reinstatement as a probationary police officer. The lower court ruled against Bonacorsa. The Appellate Division affirmed. The New York Court of Appeals affirmed the Appellate Division’s order.

    Issue(s)

    Whether a probationary police officer is entitled to an administrative hearing before termination when there is evidence of the officer’s involvement with organized crime, even if the involvement was related to prior undercover work and the officer did not disclose these contacts upon joining the police department.

    Holding

    No, because absent proof that the dismissal was for an improper reason or in bad faith, a probationary employee is not entitled to an administrative hearing concerning the reasons for dismissal. Further, the failure to disclose organized crime contacts prior to or upon entry into the police department rationally supports the dismissal.

    Court’s Reasoning

    The Court of Appeals relied on established precedent that a probationary employee can be terminated without a hearing unless the termination is for an improper reason or in bad faith. The court determined that the police commissioner’s decision to terminate Bonacorsa was rationally based, citing his involvement with organized crime and his failure to disclose these contacts. The court stated, “In light of the uncontested facts concerning petitioner’s involvement with organized crime, even assuming that those liaisons were innocently undertaken in connection with his previous employment as a so-called undercover agent, the discharge was rationally based and not arbitrary nor capricious.” This demonstrated that the police commissioner’s decision was not arbitrary or capricious, and therefore the dismissal was permissible without a hearing. The court also emphasized the importance of Bonacorsa’s non-disclosure of his organized crime contacts, stating, “Also significant and supportive of respondent’s decision is the fact that neither prior to nor upon his entry into the police department, did petitioner disclose his organized crime contacts.” The Court explicitly declined to address constitutional arguments, because the original prayer for relief only sought annulment and reinstatement, not a constitutional determination.

  • Matter of Jerry v. Board of Education, 35 N.Y.2d 384 (1974): Retroactive Application of Procedural Statutes

    Matter of Jerry v. Board of Education, 35 N.Y.2d 384 (1974)

    A statute affecting procedure applies to pending actions and proceedings unless the Legislature expresses a clear intention to the contrary, even if the underlying cause of action arose before the statute’s effective date.

    Summary

    A high school teacher, Jerry, was dismissed for conduct unbecoming a teacher. The Board of Education initiated disciplinary proceedings before an amendment to the Education Law became effective that would have provided Jerry with a hearing before a panel prior to the board’s determination. Jerry requested a hearing under the new procedure, but the Board denied it, arguing the charges were filed before the amendment’s effective date. The Court of Appeals held that the amended law, which altered the procedure of the hearing, should have been applied to Jerry’s case. The Court reversed the Appellate Division’s order and remitted the case for a new hearing in compliance with the amended statute.

    Facts

    Jerry, a high school teacher, faced dismissal by the Board of Education for alleged misconduct, neglect of duty, inefficiency, and incompetence. The charges included lying about being sick, providing students with answers to exams, preparing illegible exams with arbitrary grading, and falsifying a student’s record to ensure failure. The Board notified Jerry of the charges around June 16, 1970. The hearing commenced on July 7, 1970. Crucially, on July 1, 1970, an amendment to Section 3020-a of the Education Law became effective, changing the hearing procedure.

    Procedural History

    The Board of Education dismissed Jerry. The Appellate Division modified the Board’s determination by reducing the penalty to a suspension. Both parties appealed to the New York Court of Appeals.

    Issue(s)

    Whether the Board of Education erred in refusing to utilize the bifurcated hearing procedure established by the amended Section 3020-a of the Education Law, and if so, whether that error requires vacating the determination and remanding the case for a new hearing in compliance with the amended statute.

    Holding

    Yes, because the amendment affected the procedure to be used in connection with the petitioner’s hearing, and procedural changes generally apply to pending actions unless the Legislature indicates otherwise.

    Court’s Reasoning

    The Court reasoned that the amendment to Section 3020-a concerned procedure, not substantive rights. The Court cited Matter of Berkovitz v. Arbib & Houlberg, 230 N.Y. 261, stating the amendment merely “vindicated by a new method the obligations then existing.” The court emphasized that the statute took effect on July 1, 1970, and the hearing occurred after this date. The Court rejected the Board’s argument that applying the new procedure would be retroactive, quoting Berkovitz that procedural changes are “prospective if viewed in relation to the means of reparation.” Citing Lazarus v. Metropolitan El. Ry. Co., 145 N.Y. 581, 585, the Court stated, “The procedure in an action is governed by the law regulating it at the time any question of procedure arises.” The Court held that even though the action was brought before the amendment, the hearing arose after its effective date, requiring the Board to use the new procedures. The Court explicitly stated that they did not need to reach the merits of the Board’s appeal because a new hearing was to be held.

  • Briguglio v. New York State Board of Parole, 24 N.Y.2d 21 (1969): No Right to Counsel at Parole Release Hearings

    24 N.Y.2d 21 (1969)

    A prospective parolee does not have a constitutional right to be represented by counsel at a hearing before the Board of Parole.

    Summary

    Briguglio, convicted of attempted grand larceny, sought a new parole hearing with counsel, arguing his rights were violated when the Board of Parole denied him parole without representation or the ability to present evidence. The New York Court of Appeals affirmed the lower courts’ dismissal of his petition, holding that parole release proceedings are administrative, not judicial, and do not require adversary hearings or the right to counsel. The court emphasized parole is a statutory privilege, not a constitutional right, and the Board’s discretionary power is broad, absent statutory violations.

    Facts

    Salvatore Briguglio was convicted of attempted grand larceny and sentenced to an indeterminate term of two to four years, beginning August 5, 1966. After serving 16 months, he became eligible for parole on October 29, 1967. On August 8, 1967, the Board of Parole examined him but denied parole, deeming him a poor parole risk.

    Procedural History

    Briguglio filed a special proceeding in the Supreme Court, Albany County, seeking a declaration that the Board of Parole’s decision was unconstitutional and requesting a new hearing with counsel. The Supreme Court dismissed the petition. The Appellate Division, Third Department, affirmed the judgment without opinion. Briguglio appealed to the New York Court of Appeals on constitutional grounds.

    Issue(s)

    Whether a prospective parolee has a constitutional right to a judicial-type hearing, including the right to be represented by counsel, before the Board of Parole regarding release on parole.

    Holding

    No, because parole is a statutory privilege granted as a matter of grace, not a constitutional right, and the parole release proceeding is an administrative function, not a judicial one requiring an adversary hearing.

    Court’s Reasoning

    The Court of Appeals distinguished Mempa v. Rhay and In re Gault, cases cited by Briguglio, noting that Mempa concerned the right to counsel at sentencing (a critical stage of a criminal proceeding), not parole release, and Gault addressed due process rights in juvenile delinquency adjudications, not post-adjudicative processes like parole. The court emphasized that parole in New York is a comprehensive, legislatively created system of rehabilitation. The Board of Parole’s determination to grant parole “depends upon information in regard to the personal traits and characteristics of the individual convicted and upon unanimous concurrence of the individual members of the Board acting upon such information and personal observations” (Matter of Hines v. State Bd. of Parole, 293 N.Y. 254, 257). The Court cited Escoe v. Zerbst, stating, “'[Parole] comes as a matter of grace to one convicted of a crime, and may be coupled with such conditions * * * as [the Legislature] may impose’” (Escoe v. Zerbst, 295 U.S. 490, 492-493). The court deferred to the legislature to alter the parole system, citing the American Law Institute’s Model Penal Code, which rejects the right to counsel at parole hearings. The court also upheld the statutory provision (Correction Law § 212) deeming the Board of Parole’s actions a judicial function, not reviewable if done according to law, reaffirming its stance from Matter of Hines and refusing to involve the courts in superintending the parole system.