Firm News & Legal Alerts

Wednesday, March 21, 2012

Koch v. Sheehan

On March 23, 2012, the New York Supreme Court, Appellate Division, Fourth Department, in the case of Koch v. Sheehan, held that an exclusion from Medicaid by the New York State Office of the Medicaid Inspection General ("OMIG"), based solely on a physician’s execution of an OPMC Consent Order, without any independent investigation by the OMIG, is arbitrary and capricious conduct and thereby not permitted.  This is the first Appellate Court to rule on an ongoing conflict between the New York State Office of Professional Medical Conduct ("OPMC") and OMIG, which prior to Koch has resulted in conflicting decisions in the Supreme Courts throughout the state on whether OMIG can exclude a physician’s participation in Medicaid, solely based on the entry of an OPMC Consent Order.  This is an issue that our clients routinely face when negotiating and entering into an OPMC Consent Order. The execution of an OPMC consent order typically results in collateral issues for the physician, such as disciplinary actions by hospitals, board and professional societies, professional liability insurance carriers, and private and public payors, including New York State Medicaid.  The Koch decision is a significant victory for physicians faced with the decision of entering into an OPMC Consent Order, as OMIG must now perform its own investigation in order to take disciplinary action against the affected physician, rather than relying solely on the entry of an OPMC Consent Order.  For a copy of the Koch decision, please click here.

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