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Matter of Global Liberty Ins. Co. v. ISurply, LLC
Citation: 2018 NY Slip Op 4961Docket: 7050N
Court: Appellate Division of the Supreme Court of the State of New York; July 3, 2018; New York; State Appellate Court
Original Court Document: View Document
Global Liberty Insurance Co. (Global) appealed a decision from the Supreme Court, Bronx County, which denied its petition to vacate a master arbitrator's award and confirmed that award. The case involved reimbursement disputes over rental costs for Continuous Passive Motion (CPM) devices and Cold Therapy Units (CTU) assigned to Luis Soto by ISurply, LLC. The Appellate Division affirmed the lower court's ruling, stating that the master arbitrator’s decision was not irrational and did not ignore controlling law. The relevant regulation, 12 NYCRR 442.2(b), outlines that the maximum rental charge should not exceed either the general public's rental charge or the price set by the New York State Department of Health (DOH), with total charges capped at Medicaid fee schedule rates. Global failed to provide adequate evidence that the DOH had established a price for the rentals in question. A letter from DOH indicated a Medicaid reimbursement policy for durable medical equipment (DME) rentals lacking a Maximum Reimbursement Amount (MRA), suggesting a calculation method of 1/6th of the provider's acquisition cost. However, this was clarified by a subsequent letter stating it was not an official reimbursement rate determination. The arbitrator concluded that the 1/6th rate applied only to specific DME items listed in the Medicaid fee schedule, which did not include the CPM and CTU. Consequently, as Global did not demonstrate that the DOH had adopted the 1/6th rental fee guideline or set a rental fee, the arbitrator's conclusion that the reimbursement rate would be based on the general public's rental charge was upheld. The Appellate Division found Global's additional arguments unpersuasive. The ruling was officially documented and entered on July 3, 2018.