PETTIGREW, J.
This is an appeal by the Louisiana Department of Health and Hospitals (DHH) of an administrative adjudication that was adopted by the district court by judgment dated July 24, 2014, which reversed DHH's denial of the application of John Ford d/b/a The Clinic at Villas at Angel Point (the Clinic) to participate in the Medicaid program, and ordered DHH to grant that application and allow the Clinic to participate in the Medicaid program as a physician provider. After a thorough review of the record, we find the decision of DHH was not arbitrary and capricious and reverse the judgment of the district court.
Several years prior to the application at issue in this matter, John Ford and his wife were the owners of Angel Manor, L.L.C. (Angel Manor), which was enrolled in the Medicaid program under three separate
Thereafter, the Fords d/b/a Angel Manor filed an administrative appeal of DHH's findings. However, prior to a hearing on Angel Manor's appeal, the parties reached a settlement agreement, effective September 15, 2011. In that agreement, the parties agreed that the sum of $126,838.90 had been recouped and constituted full settlement of all of the monetary recovery at issue. Additionally, the Fords (Angel Manor) agreed to voluntarily relinquish two of its provider numbers (00045 and 17817) and retain only their adult day health care service provider number, 13449. The Fords also agreed to dismiss their appeal of the proposed sanctions. In return, DHH agreed to grant the Fords and Angel Manor a "full and final release of all administrative and/or civil claims, demands, actions, rights of action and/or causes of action brought or that could have been brought by DHH in relation to services billed by Angel Manor for the period of 06/01/04 through 12/31/09."
In February 2013, John Ford, as principal owner of the Clinic, submitted an application (the one at issue in this appeal) with DHH to enroll in the Louisiana Medicaid Program (Medicaid) as a physician group provider. In that application, John Ford properly disclosed his ownership of Angel Manor, the previous proposed sanctions, and attached a copy of the settlement agreement.
Because of the prior sanctions and the proposed five-year exclusion of Angel Manor from Medicaid, the application was routed to DHH's Program Integrity staff for review and determination. By letter dated May 21, 2013, DHH denied the application, stating that the decision was made "in the best interest of the Medicaid Program" and citing La. R.S. 46:437(9) as its authority for the denial.
John Ford, as principal owner of the Clinic, appealed the denial of its application by filing a request for administrative review of that denial, urging that the settlement agreement reached between them
The ALJ's Recommended Decision and Order was sent to the Secretary for DHH for a final administrative decision, pursuant to La. R.S. 49:992(D)(2)(b)(iii)(aa).
On July 7, 2014, a hearing was held in the district court, following which a judgment was rendered on July 24, 2014, reversing DHH's decision on the basis that its denial of the Clinic's application was arbitrary and capricious, and ordering DHH to grant said application and allow the Clinic to enroll in the Medicaid program as a physician provider. DHH appeals that judgment.
DHH asserts the district court erred by failing to apply La. R.S. 46:437.14(A)(9) and La. R.S. 46:437.13(C)(2) properly to the facts of this case. DHH further asserts the district court erred in allowing the settlement agreement between Angel Manor, LLC and DHH to "immunize" the Clinic from having its application denied on the basis of those two statutes. Finally, DHH challenges as erroneous the district court's determination that its rejection of the ALJ's recommendation was arbitrary and capricious, when such action by DHH is authorized pursuant to La. R.S. 49:992(D)(2)(b)(iii)(aa).
The assignments of error challenging the district court's failure to apply certain statutes to the facts of this case allege errors of law, which are reviewed by this court de nova Evans v. Lungrin, 97-0541 (La.2/6/98), 708 So.2d 731, 735; Bertrand v. Dow Chemical Company, 2005-1246
As to the remaining assignments of error, this court, in a recent unpublished decision, Doctors Hosp. of Augusta v. Department of Health and Hospitals, 2013-1762, pp. 3-4 (La.App. 1 Cir. 9/17/14), 2014 WL 4658202, writ denied, 2014-2163 (La. 12/8/14), 153 So.3d 444, set forth the law applicable to our standard of review of a final decision of an agency adjudication as follows:
The applicable provision of the Medical Assistance Programs Integrity Law, La. R.S. 46:437.14(A)(9), authorizes DHH to deny enrollment in Medicaid to a provider if any person having an ownership interest of five percent or greater has been sanctioned pursuant to federal or state laws relative to the Medicaid program, Medicare program, or any other public health care or health insurance program. Additionally, and in conjunction therewith, La. R.S. 46.437.13(C)(2) also grants DHH the discretionary authority to deny an application for enrollment in such programs if, based on the grounds listed in La. R.S. 46:437.14 the Secretary determines that it is in the best interest of the medical assistance programs do so, as long as DHH specifies its reasons for the denial.
The Clinic maintains that DHH was arbitrary and capricious in refusing to follow the ALJ's recommendation, and also urges that the settlement agreement entered into between Angel Manor and DHH, relating to the prior sanctions levied against it and compromising all claims DHH may have as a result thereof, prohibits DHH from denying its current application for enrollment in the Medicaid program. We disagree.
While we recognize that the settlement agreement constitutes a compromise, which by law, has a force equal to the authority of the thing adjudged; the compromise at issue herein covered all rights, claims, and/or causes of action DHH may have had relating to the actions of Angel Manor from June 2003 through December 2009. However, a compromise settles only those differences that the parties clearly intended to settle. La. C.C. art. 3076.
Notably, the settlement agreement does not mention or contain any agreement regarding future applications for enrollment in the Medicaid program by Angel Manor or the Fords. Therefore, notwithstanding the settlement agreement, DHH continued to have the statutory authority, pursuant to La. R.S. 46:437.14(A)(9), to deny any application based on the applicant having previously been sanctioned for violations of the Medicaid program. Additionally, DHH continued to have the statutory authority and discretion, pursuant to La. R.S. 46:437.13(C), based on those prior sanctions/to deny an application if the Secretary of DHH determines that it is in the best interest of the Medicaid program to do so. Neither statute requires that the prior sanctions be fully adjudicated, nor is the application of those statutes precluded by any settlement reached as to the prior sanctions. The statutory language is clear and unambiguous: it allows DHH to deny an application for enrollment as a provider in the Medicaid program based on the fact that such applicant has been previously sanctioned for violations thereunder.
A statute must be applied and interpreted in a manner that is logical and consistent with the presumed and fair purpose and intention the Legislature had in enacting it. City of Bossier City v. Vernon, 2012-0078 (La. 10/16/12), 100 So.3d 301, 305.
John Ford argues that because the Fords entered into a settlement agreement with DHH, that they were not "sanctioned" by DHH for billing violations. However, in the settlement agreement, the Fords voluntarily allowed recoupment for the alleged improper billings in the amount of $126,838.90 and they voluntarily agreed to relinquish two of their three provider numbers in exchange for DHH not pursuing any other claims or causes of action related to those billing violations.
Moreover, La. R.S. 46:437.3(27) provides that "sanction" shall include, but is not limited to any or all of the following:
(Emphasis added.)
Thus, John Ford cannot deny that he and his wife (as owners of Angel Manor) were sanctioned by DHH or that the application of the applicable provisions of law allows DHH to deny a subsequent, unrelated application for enrollment in the Medicaid program, such as the one filed by John Ford d/b/a the Clinic, on February 10, 2013. That application, which was denied, was undisputedly a new, separate, and distinct application, seeking enrollment as a physician group provider for the Clinic, a new and separate entity.
The letter from DHH, notifying John Ford d/b/a the Clinic of the denial of the application for the Clinic to enroll as a physician group provider, expressly stated that the denial was based on the fact that during the Fords and Angel Manor's previous enrollment in the Medicaid program, they had been sanctioned by DHH, and additionally noted that the decision to deny enrollment was made after a determination that it was in the best interest of the
Thus, there is no merit to John Ford d/b/a the Clinic's contention that DHH was arbitrary and capricious in refusing to accept the ALJ's recommended decision and order, when that decision and order is contrary to the clear language of the applicable statutes. Moreover, DHH acted with statutory authority in reversing the ALJ's recommended decision and order, pursuant to La. R.S. 49:992(D)(2)(b)(iii)(aa).
For the foregoing reasons, we find the district court erred in not applying the appropriate statutes to the facts of this case. Application of those statutes leads to the inescapable conclusion that DHH had the statutory authority to deny the application made by John Ford on behalf of The Clinic at Villas at Angel Point. Therefore, the district court also erred in finding DHH's denial of that application was arbitrary and capricious when, instead, it was wholly within DHH's statutory authority to do so.
Accordingly, the July 24, 2014 judgment of the district court, reversing DHH's denial of the application of The Clinic at Villas at Angel Point and ordering DHH to grant the application and to allow The Clinic at Villas at Angel Point to participate in the Medicaid program as a physician provider is reversed. Costs of this appeal are assessed to John Ford d/b/a The Clinic at Villas at Angel Point.
WELCH J. dissents and assigns reasons.
WELCH, J., dissenting.
I respectfully disagree with the majority opinion herein to reverse the judgment of the trial court. I believe that the decision of the DHH was arbitrary and capricious and that the decision of the ALJ was correct.
The evidence presented to the ALJ established that DHH denied the Clinic's application to participate in the Medicaid program as a physician provider on the basis of purported "sanctions" previously imposed on John Ford and another Medicaid provider owned by him and his wife, Angel Manor, which were set forth in a settlement agreement between the Fords/Angel Manor and DHH.
The ALJ concluded that DHH failed to support the denial of the Clinic's application on the grounds that John Ford had been previously sanctioned because as part of the settlement agreement, DHH dropped its intention to sanction the Fords and Angel Manor and Angel Manor dismissed its appeal of the sanctions and exclusion from the Medicaid program. In
Thus, I respectfully dissent.