ANALYSIS OF MAY 31, 2011 CAV OPINION[Posted May 31, 2011] The Court of Appeals of Virginia has jurisdiction over four kinds of appeals: Criminal/traffic, domestic relations, Workers’ Comp, and administrative law. By a wide margin, the scarcest supply of appeals is in the last category, accounting for just over 1% of the court’s appellate caseload. Today, we get a rare published opinion in the admin-law sector.
Department of Medical Assistance Services v. Patient Transport Systems is all about making the administrative record. The Department figured that Patient Transport had been overpaid for various service dates. It sent a letter to the company, enclosing a CD that listed various dates of service and the amount paid, but somehow omitting the amount of the claimed overpayment. In a curious arrangement whereby the Department appears to be both the complainant and the factfinder, the director ruled in favor of his agency.
A circuit court disagreed, holding that the Department had failed to adhere to an admin-law regulation requiring it to file a case summary of every appeal. That requirement looks pretty specific; see for yourself:
The case summary shall address each adjustment, patient, service date, or other disputed matter and shall state DMAS’ position for each adjustment, patient, service date, or other disputed matter. The case summary shall contain the factual basis for each adjustment, patient, service date, or other disputed matter and any other information, authority, or documentation DMAS relied upon in taking its action or making its decision. Failure to file a written case summary with the Appeals Division in the detail specified within 30 days of the filing of the provider’s notice of informal appeal shall result in dismissal in favor of the provider on those issues not addressed in the detail specified.
Today, the Court of Appeals agrees with the trial court. By sending out only a cover letter that references an obviously incomplete CD, the Department hamstrung itself by failing to abide by the administrative regulation. As the last sentence of this quoted passage makes clear, the result is inexorable: The appeal has to be dismissed in favor of Patient Transport.
The Department challenged several other aspects of the trial court’s ruling – sensibly avoiding a waiver trap – but the court today finds that it need not reach those arguments, because the case all boils down to a failure to provide the required detailed notice.