Daniel v. N.Y. State Dep't of Health
| Decision Date | 27 August 2022 |
| Docket Number | CV 21-4097 (DG)(AYS) |
| Parties | JEAN R. DANIEL, Plaintiff, v. NEW YORK STATE DEPARTMENT OF HEALTH, ADMINISTRATIVE LAW JUDGE KIMBERLY A. O'BRIEN, THE NEW YORK STATE OFFICE OF THE OF THE MEDICAID INSPECTOR GENERAL, DANIEL V. COYNE, ASSISTANT MEDICAID INSEPECTOR GENERAL STEPHANIE E. PATON, RN, WILLIAM ROGERS, EXECUTIVE ASSISTANT AT THE TOWN OF BROOKHAVEN'S DEPARTMENT OF PUBLIC SAFETY, THE TOWN O BROOKHAVEN, AND JOHN DOES #1-10, Defendants. |
| Court | U.S. District Court — Eastern District of New York |
REPORT AND RECOMMENDATION
Pro se plaintiff Jean R. Daniel (“Daniel” or “Plaintiff”) commenced this action against the New York State Department of Health (“DOH”) Administrative Law Judge Kimberly O'Brien (“ALJ O'Brien”), New York State Office of the Medicaid Inspector General (“OMIG”), Deputy Medicaid Inspector General Daniel Coyne (“DMIG”), and Assistant Medicaid Inspector General Stephanie E. Paton (“AMIG”) (collectively the ), as well as William Rogers (“Rogers”), Executive Assistant at the Town of Brookhaven's Department of Public Safety, and the Town of Brookhaven (“Brookhaven”) (collectively the “Town Defendants”) alleging inter alia violations of his rights under the: (1) Due Process Clause of the Fourteenth Amendment; (2) Equal Protection Clause of the Fourteenth and Fifth Amendments; (3) Seventh Amendment; (4) Takings Clause of the Fifth Amendment; and (5) State Administrative Procedure Act, 42 CFR Section 457.1206 and 42 CFR Section 447.45(d)(1)(4). Plaintiff also seeks a stay of his administrative appeal pending disposition of this Court and seeks to: (1) compel the appearance of Rogers and the production of records pertaining to Plaintiff's company in an administrative hearing; (2) compel OMIG to remove Plaintiff and his company from any negative and excluded lists and to restore them to the Medicaid program and (3) to transfer the administrative hearing to this Court. Additionally, Plaintiff seeks $3,8000,000 in damages.
Presently before this Court, upon referral by the Honorable Diane Gujarati for Report and Recommendation, see Order Referring Motions dated 03/07/2022, is the Town Defendants' motion to dismiss the Amended Complaint pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure, see Docket Entry (“DE”) [48], and the State Defendants' motion to dismiss the Amended Complaint pursuant to Rules 12(b)(1) and (6) of the Federal Rules of Civil Procedure. See DE [50]. As discussed below, this Court respectfully recommends that the Town Defendants' motion to dismiss be granted, the State Defendants' motion to dismiss be granted, and Plaintiff be granted leave to replead with respect to any claim not dismissed with prejudice.
As is required in the context of this motion to dismiss, the factual allegations in the Complaint, though disputed by Defendants, are accepted to be true for purposes of this motion, and all reasonable inferences are drawn therefrom in favor of the Plaintiff.
While facts to consider in the context of a Rule 12 motion to dismiss are generally limited to those set forth in the pleadings, a court may consider matters outside of the pleadings under certain circumstances. Specifically, in the context of a Rule 12(b)(6) motion, a court may consider: (1) documents attached to the Complaint as exhibits or incorporated by reference therein; (2) matters of which judicial notice may be taken; or (3) documents upon the terms and effects of which the Complaint “relies heavily” and which are, thus, rendered “integral” to the Complaint.” Chambers v. Time Warner, Inc., 282 F.3d 147, 152-153 (2d Cir. 2002); see Int'l Audiotext Network, Inc. v. Am. Tel. and Tel. Co., 62 F.3d 69, 72 (2d Cir. 1995). Moreover. “[a] court may take judicial notice of documents filed in another court not for the truth of the matters asserted in the other litigation, but rather to establish the fact of such litigation and related filings.” Glob. Network Commc'ns, Inc. v. City of New York, 458 F.3d 150, 157 (2d Cir. 2006) (quoting Int'l Star Class Yacht Racing Ass'n Tommy Hilfiger U.S.A., Inc., 146 F.3d 66, 70 (2d Cir. 1998)).
Where, as here, the amended complaint was filed pro se, it must be construed liberally with “special solicitude” and interpreted to raise the strongest claims that it suggests. Hill v. Curcione, 657 F.3d 116, 122 (2d Cir. 2011) (internal quotation marks omitted). Nonetheless, a pro se complaint must state a plausible claim for relief. See Harris v. Mills, 572 F.3d 66, 73 (2d Cir. 2009).
The Court turns now to discuss the facts set forth in Plaintiff's Amended Complaint, construed in his favor.
Plaintiff was a partner at Dove Transport Service, LP (“Dove”), a transportation provider with its principal place of business at 72 Granada Circle, Mount Sinai, NY 11766, located in the Town of Brookhaven. See Amended Complaint (“AC”) ¶¶ 1-2, Ex. 1, DE [34]. On June 19, 2014, Dove enrolled as a provider in the Medicaid program under the category of service 0603, as a “taxi.” See AC Ex. 2. At the time of the enrollment Plaintiff's business and his drivers did not have a Brookhaven issued taxi license because Plaintiff believed that because their clientele were Medicaid recipients, this constituted an exemption from licensing. See AC ¶¶ 14A-J, 69-71. In April of 2016 Dove applied for and received a taxi license from Brookhaven. See AC ¶10A, 20, Exs. 5, 14.
Subsequent to Dove's enrollment, OMIG determined it was not licensed to operate as a taxi or transportation provider until April of 2016. See AC ¶ 10A, Exs. 5, 14. After an investigation, OMIG concluded that “all of the claims which Dove submitted to the Medicaid program between July 1, 2016 and May 13, 2017 failed to include the driver's license and vehicle license plate numbers.” See AC, Ex. 5. On May 30, 2017, OMIG issued a letter informing Plaintiff of its “preliminary findings of unacceptable practices and/or significant overpayments,” and that it would temporarily withhold 25% of Dove's current and future Medicaid claims for no more than 90 days “unless a written Draft Audit Report or Notice of Proposed Agency Action is issued.” AC, Ex. 8 (“Withhold Letter”). The Withhold Letter further notified Dove that, within 30 days of the notice, it could submit written arguments and documentation that the withhold letter should be removed.” Id.
On December 10, 2018, OMIG issued a Notice of Proposed Agency Action (“NOPAA”), which set forth its findings that Dove had: (1) improperly provided taxi services without licensure between Jun 19, 2014 to April 23, 2016; (2) submitted claims to the Medicaid program between July 1, 2016 and May 13, 2017 without including the driver's license and vehicle plate numbers; and (3) failed to produce records requested by OMIG investigators in order to demonstrate the right to receive payment under the Medicaid program pursuant to 18 NYCRR 504.3(a):
Duties of the Provider.” See AC, Ex. 5. OMIG also determined that, “in accordance with 18 NYCRR 515.3, as an affiliate and owner of Dove, the conduct giving rise to the unacceptable practices alleged herein was accomplished within the course of the duties of Dove, and Daniel knew or should have known of the conduct, or the conduct was effected with Daniel's knowledge and consent.” Id. The NOPAA specifically listed all of the claims that were rejected. See id. The NOPAA further notified Plaintiff and Dove that they had thirty days to respond. Id.
On January 9, 2019, Plaintiff responded, stating that: “Jean R. Daniel cannot be excluded . . . because he has currently moved on to a different field and has no intention of ever rejoining the Medicaid program.” AC, Ex. 7, ¶ 27. AC, Ex. 7, ¶ 26. AC, Ex. 7, ¶ 30.
Plaintiff claims that “[p]rior to OMIG's issuance of such a NOPAA on December 10, 2018, OMIG did not return any of the claims submitted by [p]laintiff between July 1, 2016 and May 13, 2017 [] which it allegedly believed to have been missing the driver's license and vehicle license plate numbers so that [p]laintiff could correct.” AC ¶ 9. Plaintiff further alleges that the NOPAA “failed to provide [p]laintiff with specific instruction on how to resubmit claims.” AC ¶ 9.
On January 17, 2020, OMIG issued a Notice of Agency Action (“NOAA”), notifying Plaintiff that: (1) he will be excluded from participating in the Medicaid program for three years and until reinstated, and (2) jointly and severally liable to repay an overpayment of $395,387.59 plus interest. AC ¶ 9. OMIG later reduced the amount to $160,441.53. AC ¶ 64, Ex. 44. On February 6, 2020, OMIG placed Plaintiff, his partner and Dove on a list of excluded Medicaid providers. AC, Ex. 13.
On March 9, 2020, Plaintiff requested an administrative hearing in response to the NOAA. AC ¶ 18. The administrative hearing was scheduled, adjourned to August 19, 2021, adjourned again and remains pending. AC ¶¶ 46, 87, Exs. 31, 35, 37, 39, 41.
On May 24, 2016, defendant Rogers, an employee of Brookhaven's Division of Public Safety, issued a letter stating “Please be advised that Dove Transport is a fully licensed and certified taxi operation within The Town of...
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