Justia New York Court of Appeals Opinion Summaries

The case involves a dispute over the adjusted Medicaid reimbursement rates for for-profit residential health care facilities in New York. The New York State Department of Health and its Commissioner, in response to a legislative mandate, eliminated a component known as the "residual equity reimbursement factor" from the computation formula used to set these rates. This change was part of a broader effort to reduce Medicaid costs in the state. The petitioners, 116 for-profit nursing homes, challenged this adjustment, arguing that it was retroactively applied and violated their rights under the Public Health Law and the Equal Protection Clause.The Supreme Court partially granted the petitioners' motion for a preliminary injunction against enforcement of the clause pending a final determination of the proceeding. It also partially granted the respondents' motion for summary judgment, dismissing the petitioners' claims that the adjusted rates were not "reasonable and adequate to meet costs" under the Public Health Law and violated their equal protection rights. However, the court found that the adjusted rates were improperly applied retroactively. The Appellate Division affirmed the Supreme Court's decision.The New York Court of Appeals, in its review, held that the Department of Health did not violate the legislature's intent when it announced the recalculated rates for services provided on or after April 2, 2020. The court found that the legislature clearly expressed its intent for the elimination clause to be applied without delay, and that the initial implementing ratemaking was not subject to the usual 60-day advance notice requirement. The court also rejected the petitioners' claims that the adjusted rates were not "reasonable and adequate to meet costs" and violated their equal protection rights. The court modified the order of the Appellate Division in accordance with its opinion and, as so modified, affirmed it. View "In re Aaron Manor Rehabilitation & Nursing Ctr., LLC v Zucker" on Justia Law

The Court of Appeals accepted a question certified by the United States Court of Appeals for the Second Circuit and answered that no provide cause of action exists for violations of New York Public Health Law 18(2)(e).Plaintiff filed a complaint alleging that Defendant, a hospital, violated section 18(2)(3) by charging her $1.50 per page for paper copies of her medical records. The district court concluded that no private right of action existed under section 18(2)(e) and therefore granted Defendant's motion to dismiss. On appeal, the Second District concluded that there was insufficient precedent to resolve the issue of whether a private right of action existed. After applying the factors set forth in Sheehy v. Big Flats Community Day, 73 NY2d 629 (1989), the Court of Appeals concluded that no private cause of action exists for violations of section 18(2)(e). View "Ortiz v. Ciox Health LLC" on Justia Law

The Court of Appeals affirmed the order of the Appellate Division, holding that, under N.Y. C.P.L.R. 3122(a)(2), the Comptroller of the State of New York's subpoenas to a medical provider seeking patients' records in carrying out the Comptroller's obligation to audit payments to private companies that provide health care to beneficiaries of a state insurance program need not be accompanied by written patient authorizations.Petitioner, a professional corporation engaged in the practice of plastic surgery, was served with a subpoena duces tecum requesting the names and addresses of certain patients. Petitioner commenced this special proceeding to quash the subpoena, arguing that under C.P.L.R. 3122(a)(2) it was not obligated to respond to the subpoena. Supreme Court granted the petition and quashed the subpoena. The Appellate Division reversed. The Court of Appeals affirmed, holding that the requirements set out in C.P.L.R. 3122(a)(2) apply only to subpoenas duces tecum served after the commencement of an action, and therefore, the statute does not require that the Comptroller's subpoenas be accompanied by written patient authorizations. View "Plastic Surgery Group, P.C. v. Comptroller of the State of New York" on Justia Law

The Court of Appeals answered in the negative a question certified to it by the United States Court of Appeals for the Second Circuit asking whether N.Y. Pub. Health Law 230(11)(b) creates a private right of action for bad faith and malicious reporting to the Office of Professional Medical Conduct, holding that there is not indication that the legislature intended to create a private right of action in section 230(11)(b).Plaintiff, a surgeon, treated four injured patients insured by Defendant and submitted claims to Defendant in connection with each patient. Defendant later filed complaints with the Office of Professional Medical Conduct (OPMC) alleging insurance fraud. After OPMC declined to impose discipline against Plaintiff, Plaintiff commenced this action asserting that Defendant's complaints lacked a good-faith basis in violation of section 230(11)(b) and interposed a separate caused of action for defamation. Defendant moved to dismiss the complaint, arguing that section 230(11)(b) does not imply a private right of action. The federal district court granted the motion. On appeal, the Second Circuit certified the above question to the Court of Appeals. The Court of Appeals held that the statutory text and legislative history of the statute do not imply a legislative intent to create a right of action under section 230(11)(b). View "Haar v. Nationwide Mutual Fire Insurance Co." on Justia Law

In this insurance dispute involving an insurer withholding payments to a medical service corporation improperly controlled by nonphysicans the Court of Appeals ruled that the trial court did not err in declining to give a charge requiring the jury to find fraudulent intent or conduct "tantamount to fraud" in order to reach a verdict in favor of the insurers.Plaintiff Andrew Carothers, M.D., P.C., a professional service corporation, filed multiple collection actions against insurance carriers seeking to recover unpaid claims of assigned first-party no-fault insurance benefits. The jury found that Defendants had proved that Plaintiff was "fraudulently incorporated" and that Carothers did not engage in the practice of medicine. Plaintiff appealed, arguing that the court erred in failing to give a jury instruction on "the traditional elements of common-law fraud and fraudulent intent. The Appellate Division affirmed. The Court of Appeals affirmed, holding that the court's instructions to the jury were proper. View "Carothers v. Progressive Insurance Co." on Justia Law

The Court of Appeals held that N.Y. Mental Hyg. Law 33.13, which protects the confidentiality of the clinical records of patients and clients as maintained by facilities licensed or operated by the Office of Mental Health or the Office for People with Developmental Disabilities, does not require automatic sealing of the entire court record of all proceedings involving insanity acquittees who have dangerous mental disorders within the meaning of N.Y. Crim. Proc. Law (CPL) 330.20.Defendant, an insanity acquittee, was found to have a dangerous mental disorder as defined by CPL 330.20(1)(c) and was committed to the custody of the Commissioner for the Office for People with Developmental Disabilities. Supreme Court denied Defendant’s motion to seal the entire court record in his case, finding that the documents related to the legal proceedings rather than Defendant’s treatment. The Appellate Division modified. The Court of Appeals affirmed, holding that the legislature provided no automatic sealing requirement of an entire court record in either CPL 330.20 or the Mental Hygiene Law for an insanity acquittee, and Defendant cited no authority for such an obligation. View "In re James Q." on Justia Law

The Court of Appeals reversed the order of the Appellate Division and dismissed this petition and proceeding, holding that Mental Hygiene Legal Service (MHLS) did not have standing to bring this proceeding in its own name to vindicate its clients’ rights under N.Y. Mental Hyg. Law 9.31(b).MHLS, a government entity charged with providing legal services to patients of mental health facilities and hospitals, brought this proceeding in its own name seeking a writ of mandamus to compel a hospital to comply with section 9.31(b), which sets forth the procedure to be followed after a patient requests an admission or retention hearing. The hospital moved to dismiss the petition on the ground the MHLS lacked standing to bring the claim in its own name. Supreme Court denied the hospital’s motion to dismiss and granted the petition, concluding that MHLS had demonstrated a right to mandamus relief. The Appellate Division affirmed. The Court of Appeals reversed and dismissing both the petition and the proceeding, holding that MHLS did not have standing to bring this petition. View "Mental Hygiene Legal Service v. Daniels" on Justia Law

The Court of Appeals held that assigned Mental Hygiene Legal Services (MHLS) counsel is not entitled to be given an interview and an opportunity to participate in treatment planning meetings for article 10 respondents placed in a sex offender treatment program at a secure treatment facility simply by virtue of an attorney-client relationship with the article 10 respondent.Petitioners - an article 10 respondent called D.J. and his assigned MHLS counsel - requested that counsel be permitted to attend D.J.’s treatment planning meetings either as an “authorized representative” or a “significant individual” under N.Y. Mental Hyg. Law 29.13(b). The requests were denied, after which Petitioners commenced this N.Y. C.P.L.R. 78 proceeding. Supreme Court dismissed the petition, and the Appellate Division affirmed. The Court of Appeals affirmed, holding that MHLS counsel was not intended to be included, as a matter of law, within the terms “authorized representative” or “significant individual.” View "Mental Hygiene Legal Service v. Sullivan" on Justia Law

The New York City Board of Health’s promulgation of the flu vaccine falls within the powers specifically delegated to the New York City Department of Health and Mental Hygiene in New York City Administrative Code 17-109.At issue was the Board’s amendments to the New York City Health Code mandating that children between the ages of six months and fifty-nine months who attend city-regulated child care or school-based programs receive annual influenza vaccinations. Petitioners - parents of children enrolled in child care programs subject to the flu vaccine rules who objected to their children receiving the vaccination - commenced this hybrid N.Y. C.P.L.R. 78 proceeding and declaratory judgment action to enjoin Respondents from enforcing the flu vaccine rules. Supreme Court granted Petitioners’ motion and permanently enjoined Respondents from enforcing the flu vaccine rules. The Appellate Division affirmed. The Court of Appeals reversed, holding (1) the Board permissibly adopted the flu vaccine rules pursuant to its authority to regulate vaccinations; (2) the Board’s actions did not violate the separation of powers doctrine; and (3) the flu vaccine rules are not preempted by state law. View "Garcia v. New York City Department of Health & Mental Hygiene" on Justia Law

The Justice Center for the Protection of People with Special Needs acted within its authority under N.Y. Social Services Law 493 when it required Petitioner to undertake certain remedial measures to correct the systemic problems that led to three sexual assaults at Petitioner’s residential health care facility.The sexual assaults at Petitioner’s facility were committed by the same resident and occurred within a six-month period. After an investigation, the Justice Center substantiated allegations of neglect against Petitioner and required it to undertake certain remedial measures to correct its “systemic problems.” Petitioner brought this N.Y. C.P.L.R. 78 proceeding seeking to annul the Justice Center’s determination, contending that section 493 did not authorize the Justice Center to substantiate a finding of neglect against Petitioner and that the Justice Center’s determination was not supported by substantial evidence. The Appellate Division granted the petition and annulled the Justice Center’s determination. The Court of Appeals reversed, holding that section 493 enables the Justice Center to address systemic issues at a facility regardless of whether allegations against a particular employee are also substantiated. View "Anonymous v. Molik" on Justia Law