797 F.2d 119 (3rd Cir. 1986), 85-1691, Ritter v. Cohen

Docket Nº:85-1691, 86-1302.
Citation:797 F.2d 119
Party Name:Medicare&Medicaid Gu 35,534 Arnold RITTER, D.O., Appellant, v. Walter COHEN, Individually and in his official capacity as Secretary of the Department of Public Welfare, Commonwealth of Pennsylvania and Gerald Radke, Individually and in his official capacity as Deputy Secretary of the Department of Public Welfare, Commonwealth of Pennsylvania, Appel
Case Date:July 23, 1986
Court:United States Courts of Appeals, Court of Appeals for the Third Circuit
 
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Page 119

797 F.2d 119 (3rd Cir. 1986)

Medicare&Medicaid Gu 35,534

Arnold RITTER, D.O., Appellant,

v.

Walter COHEN, Individually and in his official capacity as

Secretary of the Department of Public Welfare, Commonwealth

of Pennsylvania and Gerald Radke, Individually and in his

official capacity as Deputy Secretary of the Department of

Public Welfare, Commonwealth of Pennsylvania, Appellees.

Nos. 85-1691, 86-1302.

United States Court of Appeals, Third Circuit

July 23, 1986

Argued June 5, 1986.

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Gilbert B. Abramson, Philip L. Blackman, Michael B. Tolcott (argued), Abramson, Cogan, Kogan, Freedman, and Blackman, P.C., Philadelphia, Pa., for appellant.

LeRoy S. Zimmerman, Atty. Gen., Joel M. Ressler (argued), Deputy Atty. Gen., John G. Knorr, III, Senior Deputy Atty. Gen., Andrew S. Gordon, Chief Deputy Atty. Gen., Chief, Litigation Section, Harrisburg, Pa., for appellees.

Before ADAMS, WEIS and HIGGINBOTHAM, Circuit Judges.

OPINION

ADAMS, Circuit Judge.

This case requires us to consider what process the state of Pennsylvania is constitutionally required to furnish when terminating a medical provider's participation in the Medicaid program. The district court rejected an osteopathic physician's due process claim, declaring that he lacked a property interest in his continued role in the program, and that even if he was entitled to constitutional protection, he received all of the process that was due. Because we agree that the provider received all of the process that was due, we will affirm.

I.

Medicaid is a joint federal-state program that makes available medical care for poor people. In Pennsylvania, Medicaid is operated as the Medical Assistance Program (MAP), and administered by the State Department of Public Welfare (DPW) pursuant to 62 Pa.Stat.Ann. Sec. 401 et seq. (Purdon's Supp.1986). Under the program, the state contracts with individual providers and institutions to perform services for eligible recipients.

Appellant Arnold Ritter is a licensed osteopathic physician in Pennsylvania. Since 1982, he has served as a MAP provider under a standard agreement with the DPW. Ritter's practice is heavily dependent on MAP-reimbursed patients; he estimates that 99% of his patients are MAP recipients.

In 1984, a peer review committee examined Ritter's medical records, and concluded that he had been providing medically unnecessary treatment for patients suffering from obesity, and that the drugs he prescribed were potentially dangerous. The committee also found that Ritter had billed DPW for methods of treatment that were "inappropriate to the diagnosis," and that he had failed to maintain adequate records.

Gerald Radke, deputy secretary of DPW for medical assistance, sent a letter dated January 18, 1985 to Ritter, informing him

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that on the basis of the review committee's findings, the agency planned to terminate his provider agreement within thirty days and to preclude his reenrollment in the program for at least five years. The letter also stated that DPW would seek restitution for the improperly prescribed treatment. The letter offered Ritter the opportunity to respond within thirty days "by documents and written argument against [the Department's proposed] action."

On February 1, Ritter's counsel submitted a four-page letter defending his medical practices and disputing the charges of the peer review committee. The Deputy Secretary, however, was not persuaded. On April 15, he informed Ritter that the Department, upon consideration of his letter, had nonetheless determined that termination was warranted. Ritter was barred as a provider effective April 30. Under DPW regulations, Ritter was further advised, he could file for an administrative hearing with the Office of Hearings and Appeals. The request for a hearing, however, would not stay the termination date, although if his appeal was successful, Ritter would be eligible for reimbursement for any services performed after the date of termination.

Ritter then petitioned for an administrative hearing in accordance with DPW regulations. He also filed suit under 42 U.S.C. Sec. 1983 (1982) in the district court, contending that his termination from the MAP without a prior hearing violated his right to procedural due process. The suit sought damages for the alleged violation, as well as injunctive relief prohibiting the defendants from terminating his provider agreement until the state's procedures were brought into compliance with constitutional standards.

The defendants filed a motion to dismiss under Fed.R.Civ.P. 12(b)(6), asserting that the facts averred in the complaint did not establish a constitutional violation. On October 7, 1985 the district court granted the motion to...

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