107 A.D.3d 28
N.Y. App. Div.2013Background
- Medicaid is a state-administered program; Medicare is a federal program; the Attorney General investigated Medicaid fraud and related Medicare fraud involving dual-eligible patients.
- DOH referral in 1978 and COH/CDSS referrals in 1978 and 2002 authorized AG to investigate Medicaid fraud.
- Attorney General’s MFCU conducted the investigation; OIG consented to continue federal adjudication.
- 31-count indictment charged false statements and fraudulent Medicare/Medicaid billing; pleas were entered admitting Medicaid/Medicare-related offenses.
- Defendants challenged AG authority under Executive Law § 63(3) and alleged preemption by 42 USCS § 1396b(q)(3); Court addressed preemption and authority.
- Judgments convicting the defendants were affirmed; the analysis found no conflict preemption or express preemption and sustained AG authority under § 63(3).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Authority of AG under Exec. Law § 63(3) to prosecute Medicare fraud | People: § 63(3) authorizes prosecution arising from Medicaid investigations. | Miran/Corporation: § 63(3) limits prosecutions to Medicaid-related offenses. | AG authority upheld; Medicare offenses connected to Medicaid investigation. |
| Express preemption under 42 USC § 1396b(q)(3) | People: no express preemption; statute does not preempt § 63(3). | Defendants: express preemption exists under § 1396b(q)(3). | No express preemption found. |
| Conflict preemption—in particular, impossibility form | People: compliance with both statutes possible; not preempted. | Defendants: conflict preemption applies. | Impossibility form not applicable; conflict not shown. |
| Conflict preemption—in particular, impediment form | People: § 63(3) aligns with federal objective; not an impediment. | Defendants: state law impedes Congressional objectives. | Impediment form inapplicable; no preemption. |
Key Cases Cited
- People v Gilmour, 98 N.Y.2d 126 (2002) (limits general authority of AG to statute-based powers)
- People v Cuttita, 7 N.Y.3d 500 (2006) (defines scope of AG prosecutorial authority)
- Matter of Mann Judd Landau v. Hynes, 49 N.Y.2d 128 (1979) (broadened interpretation of § 63(3) "arising out of" scope)
- People v Zarro, 66 A.D.3d 1050 (2009) (expands interpretation of related prosecutions under § 63(3))
- Young v. New York, 220 A.D.2d 872 (1995) (definition of arising out of in § 63(3))