Court of Appeals — Medicaid: Koch v. Sheehan

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New York State Court of Appeals

Medicaid

Physician Suspension — Authorization

Koch v. Sheehan
No. 153
Judge Read

Background: The lower court had annulled the Office of the Medicaid Inspector General’s determination to terminate the petitioner-physician’s participation in the Medicaid program on the basis of a Bureau of Professional Medical Conduct consent order, and directed his reinstatement. The order pleaded no contest to charges of professional misconduct and agreed to 36 months’ probation. The Appellate Division affirmed finding it arbitrary and capricious for the agency to bar the petitioner from treating Medicaid patients when the BPMC permitted him to continue to practice.

Ruling: The Court of Appeals held that the Office of the Medicaid Inspector General is authorized to remove a physician from New York’s medical assistance program in reliance solely on a consent order between the physician and Bureau of Professional Medical Conduct, regardless of whether BPMC chooses to suspend the physician’s license or OMIG conducts an independent investigation. The OMIG has a responsibility to insure that Medicaid dollars are spent on quality medical care for recipients.

Victor Paladino for the appellant; Susan A. Eberle for the respondent