684 N.Y.S.2d 656 | N.Y. App. Div. | 1999
Proceeding pursuant to CPLR article 78 (transferred to this Court by order of the Supreme Court, entered in Albany County) to review a determination of respondent which excluded petitioner from participation in the Medicaid program for a period of five years.
Petitioner is a physician practicing medicine in Kings County; he has been a Medicaid provider since 1987. An audit of 11 Medicaid patient records disclosed, inter alia, that petitioner failed to record adequate patient histories, routinely ordered ambulette service without documenting a medical need therefor, and routinely prescribed medications without documenting a medical basis and without monitoring patient response. Following notice to petitioner and consideration of petitioner’s response to the peer reviewer’s summary of the audit results, the Department of Social Services rendered a determination excluding petitioner from the Medicaid program for a period of five years. Following a fair hearing before an Administrative Law Judge, respondent affirmed the Department’s determination, now challenged by petitioner in this CPLR article 78 proceeding.
Initially, we conclude that there is substantial evidence in the record to support respondent’s determination that the audit of petitioner’s patient records disclosed unacceptable record-keeping
Petitioner’s remaining contentions are also found to be lacking in merit. We first note that our review of the record discloses no evidence that the Administrative Law Judge was biased against petitioner or that his determination flowed from any such bias (see, Matter of Goldsmith v DeBuono, 245 AD2d 627, 631-632; Matter of Moss v Chassin, 209 AD2d 889, 890, lv denied 85 NY2d 805, cert denied 516 US 861; see also, 10 NYCRR 51.17 [a]). Next, we are unpersuaded by the contention that petitioner was precluded from putting forth evidence
Peters, Spain, Carpinello and Graffeo, JJ., concur. Adjudged that the determination is confirmed, without costs, and petition dismissed.
18 NYCRR 515.2 (b) (6) defines unacceptable recordkeeping as “[flailing to maintain or to make available for purposes of audit or investigation records necessary to fully disclose the medical necessity for and the nature and extent of the medical care, services or supplies furnished”. In addition, 18 NYCRR 518.3 (b) provides that “[nfledical care, services or supplies ordered or prescribed will be considered excessive or not medically necessary unless the medical basis and specific need for them are documented in the client’s medical record.”