7-1800-21134-2
STATE OF
OFFICE OF ADMINISTRATIVE HEARINGS
FOR THE COMMISSIONER OF HUMAN SERVICES
|
In the Matter of the SIRS Appeal by Marina Krasichkova of the
Suspension of NPI‑A405182300 |
FINDINGS OF FACT, CONCLUSIONS, AND RECOMMENDATION |
The above-entitled matter
came on for Prehearing Conference before Administrative Law Judge (ALJ) Richard C.
Luis on April 23, 2010, at 1:30 p.m. at the Office of
Administrative Hearings in
STATEMENT OF ISSUES
1. Whether Krasichkova submitted claims for
Medicaid reimbursement for false service dates and/or times in violation of
Minnesota Statutes and Rules;
2. Whether Krasichkova, as a vendor of
medical care, demonstrated a pattern of presentment of false or duplicate
claims or claims for services;
3. Whether Krasichkova, as a vendor of
medical care, demonstrated a pattern of making false statements of material
facts for the purpose of obtaining greater compensation than that to which she
was legally entitled; and
4. Whether the Commissioner properly
suspended Krasichkova from participation in the Minnesota Health Care Program (MHCP)
for a period of two years.
Based
on all the proceedings herein, the Administrative Law Judge makes the
following:
FINDINGS OF FACT
1. The
Notice and Order for Prehearing Conference was served upon Respondent at her
last known address on file with the Department by first class postage prepaid
mail on February 16, 2010.[2] The Notice
and Order scheduled the Prehearing Conference for April 8, 2010 at 1:30 p.m.
by telephone.
2. In the
Notice and Order for Prehearing Conference, the Department alleged that Krasichkova
submitted claims for Medicaid reimbursement for false service dates and/or
times in violation of Minnesota Statutes and Rules, or otherwise demonstrated a
pattern of presentment of false or duplicate claims or claims for
services. As such, the Department
suspended Krasichkova from participation in MHCP for a period of two
years. The suspension has been stayed
pending these proceedings.
3. The Order
also required each party to submit a Notice of Appearance, which Respondent did
not file. Further, the Notice and Order for Prehearing Conference contained the
following language:
The Respondent's failure to
appear at the hearing may result in a finding that the Respondent is in
default, that the Department's allegations contained in this Notice and Order
may be accepted as true, and its proposed action may be upheld.[3]
4. On or
about April 7, 2010, the ALJ and Counsel for the Department received a letter
from Respondent requesting a continuance of the Prehearing Conference due to a
conflict in Respondent’s employment schedule. The letter further requested that the Prehearing
Conference be rescheduled for a Friday. Counsel
for the Department had no objection to the continuance.
5. The ALJ
made numerous attempts to contact Respondent by phone at her last known
telephone number to reschedule the matter to Friday, April 9, 2010. The Court was unable to reach Respondent or
otherwise leave a message as the voice mail box was always full. The ALJ was informed by Counsel for the
Department that his attempts to reach Respondent were similarly
unsuccessful.
6. Thereafter,
the ALJ issued correspondence to Respondent dated April 12, 2010, rescheduling
the Prehearing Conference for Friday, April 23, 2010, at 1:30 p.m.
The letter provided for Respondent to
appear by telephone. There was also a
reminder to Respondent to provide the ALJ with current contact
information. This correspondence was
mailed to Respondent at the same address as the Notice and Order for Hearing.
7. The
Respondent did not file a Notice of Appearance with the Office of Administrative
Hearings, did not appear on the rescheduled hearing date, did not make another
prehearing request for a continuance, request any other relief, or make any
other contact with the ALJ or Department counsel. The Respondent is, therefore, in default.
8. The
allegations and issues set forth in the Notice and Order for Prehearing Conference
are incorporated herein by reference in their entirety.
Based on the Findings of
Fact, the Administrative Law Judge makes the following:
CONCLUSIONS
1. The Commissioner of Human Services and
the Administrative Law Judge have authority to consider the issues set out in
the Notice and Order for Prehearing Conference to take the action proposed
under Minn. Stat. §§ 14.50, 256B.04, subd. 10; and 256B.064 (2008), as
well as Minnesota Rules 9505.0180; 9505.0295; 9505.0335; 9505.0465;
and 9505.2160‑.2245 (2007).
2. The Department and the Office of
Administrative Hearings gave proper notice of the Prehearing Conference in this
matter to the Respondent and have complied with all procedural requirements.
3. The Respondent is in default under Minn.
R. 1400.6000 as a result of her failure to appear at the Prehearing Conference.
4. Under
5. The allegations in the Notice are
sufficient to establish a factual predicate for the Department to conclude that
Krasichkova submitted claims for Medicaid reimbursement for false service dates
and/or times in violation of Minnesota Statutes and Rules, or otherwise
demonstrated a pattern of presentment of false or duplicate claims or claims
for services. As such, the Department
properly suspended Krasichkova from participation in MHCP for a period of two
years.
Based
on the Conclusions, the Administrative Law Judge makes the following:
RECOMMENDATION
IT IS RECOMMENDED that the Commissioner of Human Services AFFIRM the SUSPENSION of
the Respondent from participation in MHCP for a period of two (2) years, and
that the appeal of that suspension be DISMISSED,
WITH PREJUDICE.
Dated: June _11th_, 2010
__/s/
Richard C. Luis _
RICHARD
C. LUIS
Administrative
Law Judge
Reported: Default
NOTICE
This
report is a recommendation, not a final decision. The Commissioner of Human Services will make the final
decision after a review of the record.
The Commissioner may adopt, reject or modify these Findings of Fact,
Conclusions, and Recommendations. The
parties have 10 calendar days after receiving this report to file Exceptions to
the report. At the end of the exceptions
period, the record will close. The
Commissioner then has 90 days to issue his final decision. If no decision is made by the Commissioner by
the end of those 90 days, this Report will become the final order of the
Department. Parties should contact Cal Ludeman, Commissioner
of the Minnesota Department of Human Services,
Under
Minn. Stat. § 14.62, subd. 1, the agency is required to serve its final
decision upon each party and the Administrative Law Judge by first class mail
or as otherwise provided by law.