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Sisters of Charity Hospital v. Daines
Citations: 84 A.D.3d 1757; 922 N.Y.S.2d 903
Court: Appellate Division of the Supreme Court of the State of New York; May 6, 2011; New York; State Appellate Court
The Supreme Court, Erie County, initially granted a petition by the petitioner challenging its Medicaid reimbursement rates from January 1985 through August 2009, remitting the matter for a hearing. However, the appellate court unanimously reversed this judgment, dismissing the petition. The court determined that the petitioner failed to adequately claim that the calculation of its Medicaid reimbursement rates was unreasonable or inadequate under Public Health Law § 2807(3). Furthermore, the petitioner acknowledged that its administrative appeal regarding reimbursement rates prior to 2001 was time-barred and that appeals for the years 2002 and 2003 were also time-barred under 10 NYCRR former 86-1.61(b)(4)(d). For the rate years 2004 through 2009, the court ruled that the petitioner did not meet the heavy burden required to challenge the agency’s reimbursement determination, which must be upheld if rational. The interpretation of Medicaid regulations by the agency was deemed not irrational, even if alternative interpretations existed. Thus, the appellate court concluded that the lower court erred in granting the petition concerning all contested years.