Fast Help Ambulette, Inc. v. N.Y. State Dep't of Health

• Decision Date: 13 October 2021
• Docket Number: 2018-05110,Index 518385/17
• Parties: In the Matter of Fast Help Ambulette, Inc., Petitioner, v. New York State Department of Health, et al., Respondents.
• Court: New York Supreme Court

In the Matter of Fast Help Ambulette, Inc., Petitioner,
v.
New York State Department of Health, et al., Respondents.

No. 2018-05110

Index No. 518385/17

Supreme Court of New York, Second Department

October 13, 2021

Argued - September 17, 2021

D67421 Y/htr

Sinayskaya Yuniver, P.C., Brooklyn, NY (Steven R. Yuniver of counsel), for petitioner.

Letitia James, Attorney General, New York, NY (Anisha S. Dasgupta and Philip V. Tisne of counsel), for respondents.

WILLIAM F. MASTRO, J.P., ROBERT J. MILLER, FRANCESCA E. CONNOLLY, VALERIE BRATHWAITE NELSON, JJ.

DECISION & JUDGMENT

Proceeding pursuant to CPLR article 78 to review a determination of a designee of the Commissioner of the New York State Department of Health dated May 25, 2017. The determination, after a hearing, upheld the determination of the New York State Office of the Medicaid Inspector General to recover Medicaid overpayments in the amount of $1, 102, 553 from the petitioner.

ADJUDGED that the determination is confirmed, the petition is denied, and the proceeding is dismissed on the merits, with costs.

The petitioner is a transportation vendor enrolled as a provider in the New York State Medical Assistance Program (hereinafter Medicaid). In June 2011, the respondent State of New York Office of the Medicaid Inspector General (hereinafter OMIG), an independent office within the respondent New York State Department of Health (hereinafter DOH) responsible for the investigation, detection, and prevention of Medicaid fraud, waste, and abuse, in connection with the respondent Human Resources Administration (hereinafter HRA), commenced an audit of 150 random samples of Medicaid claims submitted by the petitioner between January 1, 2008, through December 31, 2010. OMIG issued its draft audit report in connection with the petitioner's audit by letter dated November 12, 2013 (hereinafter the DAR). The DAR stated that the petitioner's failure to comply with the DOH's regulations resulted in a total sample overpayment of $3, 355.20. The DAR further stated that the statistical sampling methodology employed allowed for extrapolation of the sample findings to the universe of cases and the adjusted mean per unit point estimate of the amount overpaid was $1, 102, 553. In its detailed findings, the DAR stated that in 36 instances, the claims contained inaccurate vehicle plate numbers, and in 11 instances, the claims contained inaccurate driver license numbers. The DAR also stated that in 12 instances, the petitioner did not ensure that its driver complied with Department of Motor Vehicles (hereinafter DMV) certification requirements under Vehicle and Traffic Law article 19-a.

The petitioner's attorney responded to the DAR by letter dated January 31, 2014, and raised certain objections. OMIG issued its final audit report (hereinafter FAR) by letter dated June 12, 2014, which, inter alia, determined that $1, 102, 553 in Medicaid overpayments should be recovered from the petitioner. The petitioner's attorney responded to the FAR by letter dated June 14, 2017, and requested a hearing.

The hearing commenced on September 29, 2016, before the respondent Denise Lepicier, an administrative law judge (hereinafter the ALJ). During the hearing, Tricia Smith, who was employed by OMIG as a management specialist-1, and Ping Tran, who was employed by HRA as a management auditor,...