Nkanginieme v. Ohio Dept. of MedicaidNkanginieme v. Ohio Dept. of Medicaid
Rendered on February 24, 2015
Brennan, Manna & Diamond, LLC, Scott P. Sandrock, and Gregory L. Watkins, for appellant.
Michael DeWine, Attorney General, and Allan K. Showalter, for appellee.
APPEAL from the Franklin County Court of Common Pleas
SADLER, J.
{¶ 1} Plaintiff-appellant, Ikemefuna Nkanginieme, M.D., appeals from the judgment of the Franklin County Court of Common Pleas granting the motion to dismiss filed by defendant-appellee, Ohio Department of Medicaid (“ODM“), for lack of subject-matter jurisdiction over appellant“s
I. BACKGROUND
{¶ 2} Appellant is a physician and Medicaid provider in Stark County, Ohio. On January 15, 2014, ODM suspended appellant“s Medicaid provider agreement (“provider agreement“) and corresponding payments pursuant to
{¶ 3} ODM sent appellant notice of the suspension by letter dated January 17, 2014. The notice, signed by ODM“s chief of the Bureau of Provider Services, informed appellant of the suspension and stated that ODM “has determined that a credible allegation of fraud exists based on evidence submitting claims and receiving reimbursements for services not provided. An investigation is pending under the Medicaid program against you.” (Jan. 17, 2014 Notice of Suspension Letter, 1.)
{¶ 4} In the notice, ODM also informed appellant that the “suspension will remain in effect until: 1. ODM or the Attorney General“s Office determines that there is insufficient evidence to support the allegation of fraud; or 2. Legal proceedings related to the provider“s alleged fraud are completed.” (Jan. 17, 2014 Notice of Suspension Letter, 1.) The notice then describes appellant“s option, pursuant to
{¶ 5} Following receipt of the notice, appellant“s attorney contacted ODM and the Ohio Attorney General“s office to learn additional information about the allegations of fraud. An ODM representative indicated that “a question was raised regarding billing” for the service date of October 1, 2009. (Feb. 12, 2014 Request for Reconsideration Letter, 3.)
{¶ 6} On February 12, 2014, appellant submitted a timely request for reconsideration to ODM along with the required written information. Appellant provided information about the October 1, 2009 date of service, described the importance of his continued care to Medicaid patients, and asserted that due process required more information for a meaningful opportunity to respond. Appellant also “acknowledge[d] that approximately two years ago a request was made for his office to provide copies of multiple patient records,” and he provided those specific records, presumably to either ODM or the Attorney General“s office. (Feb. 12, 2014 Request for Reconsideration Letter, 3.)
{¶ 7} By letter dated April 8, 2014 and mailed April 11, 2014, ODM informed appellant that it had conducted an administrative review, pursuant to
{¶ 8} On April 22, 2014, appellant submitted a notice of appeal to both ODM and the Franklin County Court of Common Pleas. In the notice of appeal, appellant indicated the appeal is “pursuant to Chapter 119 of the Ohio Revised Code from the Order of the Ohio Department of Medicaid * * * dated April 8, 2014.” In addition to reserving the right to add additional errors after reviewing the record, appellant stated four “grounds for the appeal and the errors complained of“:
I. The Order of the Ohio Department of Medicaid should be reversed on the basis that the Order is not supported by reliable, probative and substantial evidence and is not otherwise in accordance with law;
II. Appellant was denied due process in violation of the Ohio and United States Constitutions when the State did not provide Appellant a meaningful opportunity to be heard;
III. The Ohio Department of Medicaid failed to respond within forty-five (45) days after Appellant“s request for reconsideration as required by law;
IV. Appellant was denied due process in violation of the Ohio and United States Constitutions when the State did not specify the facts upon which it based its decision, did not respond to mitigating factors described by Appellant, and the decision conflicted with requirements with the Ohio Medical Board.
{¶ 9} After first securing an extension for certifying a record and filing merit briefs, on June 3, 2014, ODM filed a motion to dismiss asserting the trial court lacked subject-matter jurisdiction over an
{¶ 10} On June 26, 2014, the trial court granted ODM“s motion and dismissed appellant“s notice of appeal with prejudice. According to the trial court, the “suspension of a Medicaid provider agreement pending a fraud investigation is not appealable pursuant to
II. ASSIGNMENTS OF ERROR
{¶ 11} Appellant raises the following assignments of error for our review:
[I.] The Franklin County Court of Common Pleas erred as a matter of law by holding that Appellee“s denial of Dr. Ikemefuna Nkanginieme“s Medicaid provider agreement is not an adjudication.
[II.] The Franklin County Court of Common Pleas erred as a matter of law by holding that R.C. § 5164.36 prohibits appellate review of Appellee“s suspension of Dr. Ikemefuna Nkanginieme“s Medicaid provider agreement.
[III.] The Franklin County Court of Common Pleas erred as a matter of law when it granted Appellee“s Motion to Dismiss pursuant to R.C. § 5164.36 as such statute is unconstitutional as it violates Dr. Ikemefuna Nkanginieme“s Constitutional right to due process.
[IV.] The Franklin County Court of Common Pleas erred as a matter of law by failing to afford Dr. Ikemefuna Nkanginieme his Constitutional right to due process.
III. DISCUSSION
A. Standard of Review
{¶ 12} A trial court“s decision to dismiss a case for lack of subject-matter jurisdiction is a question of law reviewed by the appellate court de novo. Daniel v. Williams, 10th Dist. No. 10AP-797, 2011-Ohio-1941, ¶ 9, citing Ford v. Tandy Transp., Inc., 86 Ohio App.3d 364, 375 (4th Dist.1993).
{¶ 13} In reviewing whether the trial court has subject-matter jurisdiction, an appellate court must determine “whether the complaint has raised any cause of action which the court has authority to decide.” Id., citing State ex rel. Bush v. Spurlock, 42 Ohio St.3d 77, 80 (1989); McHenry v. Indus. Comm., 68 Ohio App.3d 56, 62 (4th Dist.1990). In other words, this court must independently determine whether the notice of appeal here, standing in for the complaint, “contains sufficient allegations to demonstrate that the common pleas court has jurisdiction over the asserted claims.” Daniel. Like the trial court, we may consider material in the notice as well as other material pertinent to determining jurisdiction. Id., citing Southgate Dev. Corp. v. Columbia Gas Transm. Corp., 48 Ohio St.2d 211 (1976), paragraph one of the syllabus. Interpretation of statutory authority, as a question of law, also requires de novo review without deference to the trial court“s findings. State v. Consilio, 114 Ohio St.3d 295, 2007-Ohio-4163, ¶ 8.
B. First Assignment of Error
{¶ 14} In his first assignment of error, appellant essentially contends that the Franklin County Court of Common Pleas has subject-matter jurisdiction over the appeal for two reasons: (1) ODM“s suspension of his provider agreement is an “adjudication” under the Medicaid statute, specifically section
{¶ 15} Subject-matter jurisdiction refers to the statutory or constitutional power of a court to hear a case. Groveport Madison Local School Bd. of Edn. v. Franklin Cty. Bd. of Revision, 137 Ohio St.3d 266, 2013-Ohio-4627, ¶ 25, citing Pratts v. Hurley, 102 Ohio St.3d 81, 2004-Ohio-1980, ¶ 11. In the context of administrative appeals, “[c]ourts of common pleas only have “such powers of review of proceedings of administrative officers and agencies as may be provided by law.” ” Clifton Care Ctr. v. Ohio Dept. of Job & Family Servs., 10th Dist. No. 12AP-709, 2013-Ohio-2742, ¶ 9, quoting Ohio Constitution, Article IV, Section 4. See also Midwest Fireworks Mfg. Co. v. Deerfield Twp. Bd. of Zoning Appeals, 91 Ohio St.3d 174, 177 (2001) (“The right to appeal an administrative
{¶ 16} To determine whether
{¶ 17} Turning to appellant“s first argument, we disagree that the suspension here is an adjudication appealable, pursuant to
(C) Except as provided in division (E) of this section * * *, the department shall do any of the following by issuing an order pursuant to an adjudication conducted in accordance with Chapter 119. of the Revised Code:
* * *
(3) Suspend or terminate a medicaid provider“s provider agreement;
* * *
(D) Any party who is adversely affected by the issuance of an adjudication order under division (C) of this section may appeal to the court of common pleas of Franklin county in accordance with section 119.12 of the Revised Code.
(E) The department is not required to comply with division (C)(1), (2), or (3) of this section whenever any of the following occur:
* * *
(5) Pursuant to either section 5164.36 or 5164.37 of the Revised Code, the medicaid provider“s provider agreement is suspended and payments to the provider are suspended pending indictment of the provider.
* * *
(9) The medicaid provider“s provider agreement is suspended, terminated, or not revalidated because of * * * [a]ny reason authorized or required by * * * 42 C.F.R.* * * 455.23.
{¶ 18}
{¶ 19} Thus, under the plain language of the statute, suspensions of provider agreements based on credible allegations of fraud do not issue as adjudication orders under
{¶ 20} In his second argument to his first assignment of error, appellant maintains that the April 8, 2014 reconsideration letter, signed by the ODM director and containing a “determination,” fits the definition of “adjudication,” which he believes entitles him to an
{¶ 21} The right to an
{¶ 22} To meet this definition, appellant equates the April 8, 2014 reconsideration letter here to a letter determined to be an adjudication in Miller v. Crawford, 7th Dist. No. 06-MA-38, 2006-Ohio-4689. Miller involved a day care provider“s
{¶ 23} We agree with appellant that the April 8, 2014 reconsideration letter was a determination made by ODM“s highest authority: the letter was signed by ODM“s director and states ODM “determined” credible allegations of fraud remain. However, both the definition of adjudication and the right-to-appeal language in
{¶ 24} The
{¶ 25} The ODM is not specifically named in the definition.
{¶ 26} The general decisions and actions listed in
C. Second Assignment of Error
{¶ 27} In his second assignment of error, appellant contends
{¶ 28}
Pursuant to the procedure specified in division (H)(2) of this section, a medicaid provider or owner subject to a suspension under this section may request a reconsideration of the suspension. The request shall be made not later than thirty days after receipt of a notice required by division (E) of this section. The reconsideration is not subject to an adjudication hearing pursuant to Chapter 119. of the Revised Code.
(Emphasis added.)
{¶ 29} In the
{¶ 30} It is clear that the language of
D. Third and Fourth Assignments of Error
{¶ 31} Because they are interrelated, we will review appellant“s third and fourth assignments of error collectively. Together, these assignments assert that, in dismissing the case, the common pleas court erred as a matter of law due to various violations of appellant“s constitutional right to due process. Specifically, appellant contends the trial court erred because
{¶ 32} Appellant brought his appeal “pursuant to Chapter 119.” (Apr. 22, 2014 Notice of Appeal, 1.) While “[g]enerally, decisions of administrative agencies are always subject to review,” due process does not require an appeal under
IV. CONCLUSION
{¶ 33} Having determined that suspensions of Medicaid provider agreements due to credible allegations of fraud are not subject to
Judgment affirmed.
DORRIAN and T. BRYANT, JJ., concur.
T. BRYANT, J., retired, formerly of the Third Appellate District, assigned to active duty under authority of the Ohio Constitution, Article IV, Section 6(C).