State ex rel. Nebraska Health Care Ass'n v. Department of Health and Human Services Finance and Support
| Citation | 255 Neb. 784,587 N.W.2d 100 |
| Decision Date | 18 December 1998 |
| Docket Number | No. S-97-941,S-97-941 |
| Parties | STATE of Nebraska ex rel. NEBRASKA HEALTH CARE ASSOCIATION, appellant, v. DEPARTMENT OF HEALTH AND HUMAN SERVICES FINANCE AND SUPPORT and Jeff Elliott, in his official capacity as Director of Finance and Support for the Department of Health and Human Services Finance and Support, appellees. |
| Court | Supreme Court of Nebraska |
Syllabus by the Court
1. Mandamus: Proof. When a writ of mandamus is sought pursuant to Neb.Rev.Stat. § 84-712.03 (Reissue 1994), the party seeking the writ must first show (1) that the party is a citizen of the state or other person interested in the examination of the public records, (2) that the document sought by the party is a public record, and (3) that the party has been denied access to the public record; thereafter, if the public body holding the record wishes to oppose the issuance of a writ of mandamus, the public body must show, by clear and conclusive evidence, that the public record at issue is exempt from the disclosure requirement under one of the exceptions provided by Neb.Rev.Stat. § 84-712.05 (Cum.Supp.1998) or § 84-712.08 (Reissue 1994).
2. Mandamus: Judgments: Appeal and Error. An action for a writ of mandamus is a law action, and in an appellate review of a bench trial of a law action, a trial court's factual findings have the effect of a jury verdict and will not be set aside unless clearly erroneous.
3. Estoppel: Equity: Appeal and Error. A claim of equitable estoppel rests in equity, and in an appeal of an equity action, an appellate court tries factual questions de novo on the record and reaches a conclusion independent of the findings of the trial court.
4. Administrative Law: Records: Words and Phrases. Pursuant to Neb.Rev.Stat. § 84-712.05 (Cum.Supp.1998), a public record is an investigatory record where (1) the activity giving rise to the document sought is related to the duty of investigation or examination with which the public body is charged and (2) the relationship between the investigation or examination and that public body's duty to investigate or examine supports a colorable claim of rationality.
5. Administrative Law: Records. If a document is compiled ancillary to an agency's administrative function, then it is not protected from disclosure under the public records statutes; when, however, an inquiry by an administrative agency departs from the routine and focuses with special intensity on a particular party, an investigation is underway for purposes of the investigatory records exception.
6. Administrative Law: Records: Words and Phrases. Disclosure, within the meaning of Neb.Rev.Stat. § 84-712.05 (Cum.Supp.1998), refers to the exposure of documents to public view and not simply to the transmission of a document to the subject of an agency's investigation.
7. Statutes: Presumptions: Legislature: Intent: Appeal and Error. In construing a statute, it is presumed that the Legislature intended a sensible, rather than an absurd, result; an appellate court will, if possible, try to avoid a construction which would lead to absurd, unconscionable, or unjust results.
Administrative Law: Records: Words and Phrases. Records "disclosed" within the meaning of Neb.Rev.Stat. § 84-712.05 (Cum.Supp.1998) are only those records that a public body has, in its official capacity, already made available to the general public.
9. Estoppel. The elements which must be satisfied for equitable estoppel to apply are, as to the party estopped, (1) conduct which amounts to a false representation or concealment of material facts or, at least, which is calculated to convey the impression that the facts are otherwise than, and inconsistent with, those which the party subsequently attempts to assert; (2) the intention, or at least the expectation, that such conduct shall be acted upon by, or influence, the other party or persons; and (3) knowledge, actual or constructive, of the real facts; and, as to the other party, (4) lack of knowledge and of the means of knowledge of the truth as to the facts in question; (5) reliance, in good faith, upon the conduct or statements of the party to be estopped; and (6) action or inaction based thereon of such a character as to change the position or status of the party claiming the estoppel, to his injury, detriment, or prejudice.
10. Estoppel. The doctrine of equitable estoppel will not be invoked against a governmental entity except under compelling circumstances where right and justice so demand; in such cases, the doctrine is to be applied with caution and only for the purpose of preventing manifest injustice.
Abbie J. Widger, of Nelson Morris & Titus, Lincoln, for appellant.
Don Stenberg, Attorney General, Royce N. Harper, and Cecile A. Brady, Lincoln, for appellees.
The Nebraska Health Care Association (NHCA), the relator-appellant, sued the Nebraska Department of Health and Human Services Finance and Support and its director (collectively Department), seeking a writ of mandamus to compel the Department to release certain documents pursuant to the public records statutes, Neb.Rev.Stat. §§ 84-712 through 84-712.09 (Reissue 1994 & Cum.Supp.1998). The documents sought were created by the Department as part of its supervision of medicaid payments to Nebraska nursing homes. The documents were requests for information sent by the Department to nursing homes as part of the Department's audits of the claims for reimbursement submitted annually by the nursing homes. The issue presented in this case is whether those documents are records produced in the course of an investigation, such that they are exempt from disclosure under the public records statutes.
The NHCA is a nonprofit corporation that represents nursing homes and intermediate care facilities in the State of Nebraska. The NHCA sued the Department after the Department refused part of the NHCA's request to review documents relating to the Department's administration of nursing home medicaid reimbursement.
On March 27, 1997, the NHCA had submitted a written request to the Department to review public records as authorized by the public records statutes. The requests generally dealt with records relating to the audit process used by the Department to verify the expenditure claims made by nursing homes seeking medicaid reimbursement. In a letter dated April 3, the Department indicated generally that access to the records would be provided and suggested that the parties meet to coordinate the inspection.
In a letter dated April 23, 1997, the NHCA memorialized the events of an April 22 meeting with the Department. The letter indicated the Department's agreement to allow access to most of the documents but indicated reservations by the Department regarding two particular requests. The NHCA began copying documents on June 16. On July 1, a letter was sent to the NHCA by the Department, as required by § 84-712.04, officially denying access to the documents described by the two remaining requests at issue.
To obtain access to the documents, the NHCA sought a writ of mandamus in the district court, as authorized by § 84-712.03. A hearing was held at which witnesses from the Department and the NHCA testified about the audit process and the nature of the documents at issue. The documents themselves were not examined by the court, with the exception of one audit record that was mistakenly given to the NHCA by the Department.
After the hearing, the district court denied the NHCA's request, finding, based on the evidence presented, that the documents requested fell within the investigatory records exception to the public records statutes, as set forth in § 84-712.05(5). The NHCA appeals.
The contested requests seek documents relating specifically to the auditing process of the Department. Each year, every nursing home in Nebraska submits detailed cost reports that are used by the Department to calculate the rates at which each facility will receive medicaid reimbursement payments. Cost reports are forms issued by the Nebraska medicaid program in order to gather data and supporting information from nursing homes about the nursing homes' expenses.
These reports are audited by the Department in order to verify that the costs reported are accurate. Moreover, certain expenses of nursing homes are not compensated by medicaid, and the audits are used to distinguish compensable from noncompensable expenses. Two types of audit are used by the Department to verify cost reports: desk audits and field audits.
A desk audit generally occurs every year for each of Nebraska's 230 nursing homes. For a desk audit, an auditor reviews the cost report submitted by the facility and then sends written requests to the facility, seeking documentation for particular aspects of the cost report. The auditor may seek additional documentation for reported costs that seem unusual or are not described in sufficient detail for the Department to determine whether or not they are compensable.
A field audit is more extensive and utilized less often. The Department conducts about 20 to 30 field audits per year, in which an auditor goes "on site" to the nursing home and reviews every aspect of that nursing home's cost report by checking the report against the records that the nursing home maintains. While a field audit is in progress, or after the field work has been completed but before a final report is issued, the auditor may send written requests to the nursing home for additional information the auditor believes to be necessary.
The public records sought by the NHCA and retained by the Department are the written communications from the Department to the nursing homes that are sent out as a part of desk and field audit process. Essentially, the NHCA wants copies of the letters that the...
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