ARTIFICIAL INTELLIGENCE IS NOT USED, IN WHOLE OR IN PART, IN THE SUMMARIES OF JUDICIAL AND QUASI-JUDICIAL DECISIONS PREPARED BY NYPPL

April 27, 2022

Claimant's failing to report work performed while receiving workers' compensation benefits results in his permanent disqualification from receiving future benefits

A claimant for Workers' Compensation Benefits [Claimant] appealed a decision of the Workers' Compensation Board which, among other things, found Claimant violated Workers' Compensation Law §114-a by failing to report work that he had performed while receiving benefits. The penalty imposed by the Board: permanently disqualifying Claimant from receiving future wage replacement benefits.

The Appellate Division's decision in this action notes that the record indicated that although Claimant had represented on forms submitted to the insurance carrier that he had not engaged in any work for any employer or for his own business since the date of the accident, Claimant's hearing testimony and his social media posts indicated that he had performed certain "side jobs, including concrete work, plaster work and painting ... for which he was paid" while he was receiving workers' compensation benefits.

Noting that omitting "material information" may constitute a knowing false statement or misrepresentation, the Appellate Division sustained the Board's decision. The court explained that determining whether a claimant seeking workers' compensation benefits has violated Workers' Compensation Law §114-a is within the province of the Board. In addition, said the Appellate Division, the Board is "the sole arbiter of witness credibility, and its decision will not be disturbed if supported by substantial evidence."

Citing Kornreich v Elmont Glass Co., Inc., 194 AD3d 1322, the Appellate Division sustained the Board's decision, noting that "the Board's determination that [Claimant's] failure to disclose his work activities constituted a knowing misrepresentation in violation of Workers' Compensation Law §114-a and was supported by substantial evidence." To the extent that Claimant relied on "exculpatory evidence" in support of his claim, the Appellate Division opined that this created "a credibility issue for the Board's resolution."

Click HERE to access the text of the Appellate Division's decision.

April 26, 2022

Employee found guilty of charges of excessive absences from work and latenesses terminated from the position

In this CPLR Article 78 action challenging the termination of an employee found guilty of incompetence and misconduct due to excessive absences caused by physical incapacity, the Appellate Division, citing Romano v Town Bd. of Town of Colonie, 200 AD2d 934, observed that although the employee may offer "a valid" reason for each one of the individual absences set out in the disciplinary charges at issue that fact "is irrelevant to the ultimate issue of whether his [or her] unreliability and its disruptive and burdensome effect on the employer rendered him [or her] incompetent to continue his [or her] employment."

Citing Matter of Cupo v Uniondale Fire Dist., 181 AD3d 594, the court explained that judicial review of factual findings made after a hearing pursuant to Civil Service Law §75 "is limited to consideration of whether the determination was supported by substantial evidence." Further, the Appellate Division noted that "A reviewing court 'may not weigh the evidence or reject the choice made by [the administrative agency] where the evidence is conflicting and room for choice exists.'"

Finding that substantial evidence* in the record supports the determination that the employee was guilty of incompetence and misconduct as charged, with the employee's failure to give more than a few hours of advance notice for any of these absences, was disruptive and burdensome in that the employee's supervisor was forced to perform the employee's work in addition to the supervisor's own tasks. Further, opined the Appellate Division, the fact that the employee received "retroactive authorization" for some of these absences is "irrelevant to the ultimate issue" here: the employee's unreliability had a disruptive and burdensome effect, rendering the employee incompetent.

Applying the Pell doctrine,** the Appellate Division found that on the record before it, imposing the penalty of termination was not "'so disproportionate to the offense as to be shocking to one's sense of fairness" and this did not constituting an abuse of discretion as a matter of law.

* Substantial evidence has been defined as such relevant proof as a reasonable mind may accept as adequate to support a conclusion or ultimate fact [Matter of Berenhaus v Ward, 70 NY2d 436].

**See Pell v Board of Educ. of Union Free School Dist. No. 1 of Towns of Scarsdale & Mamaroneck, Westchester County, 34 NY2d 222.

Click HERE to access the Appellate Division's ruling.

April 25, 2022

Determining if a statement alleged to have been made by a party constitutes defamation of a public entity or it members for the purposed of litigation

The members of a town planning board [Board] commenced a lawsuit in Supreme Court to recover damages claimed to have resulted from allegedly defamatory statements made by the Defendants contained in a letter published on the "opinion" page of a nonparty newspaper. The Defendants moved pursuant to CPLR 3211(a)(7) to have Supreme Court dismiss the Boards complaint. Supreme Court granted Defendants' motion and the Board appealed the court's ruling.

In its decision the Appellate Division, citing Stone v Bloomberg L.P., 163 AD3d 1028, quoting Greenberg v Spitzer, 155 AD3d 27: "The elements of a cause of action for defamation are (a) a false statement that tends to expose a person to public contempt, hatred, ridicule, aversion, or disgrace, (b) published without privilege or authorization to a third party, (c) amounting to fault as judged by, at a minimum, a negligence standard, and (d) either causing special harm or constituting defamation per se."

However, explained the court, "Whether a particular statement constitutes an opinion or objective fact is a question of law," [see Mann v Abel, 10 NY3d at 276]. Further, said the Appellate Division, in determining whether a challenged statement is opinion or fact, the factors to be considered by courts are:

"(1) whether the specific language at issue has a precise, readily understood meaning;

"(2) whether the statements are capable of being proven true or false; and

"(3) whether either the full context of the communication in which the statement appears or the broader social context and surrounding circumstances are such as to signal readers that what is stated is likely to be opinion, not fact."

Applying these factors in the instant case, the Appellate Division concluded that Supreme Court "properly determined that the statements at issue constituted nonactionable expressions of opinion."

Although the Board had contend that the statements at issue "are reasonably susceptible of defamatory connotations," the Appellate Division opined that the Board's complaint failed to "make a rigorous showing that the language of the [article] as a whole can be reasonably read both to impart a defamatory inference and to affirmatively suggest that the [Defendants] intended or endorsed that inference," citing Udell v NYP Holdings, Inc., 169 AD3d at 957, quoting Stepanov v Dow Jones & Co., Inc., 120 AD3d 28, 37-38.

Accordingly, the Appellate Division sustained Supreme Court's ruling.

Click HEREto access the Appellate Division's decision.

April 23, 2022

Audits and reports issued by the New York State Comptroller during the week ending April 22, 2022

New York State Comptroller Thomas P. DiNapoli announced the following audits and reports were issued during the week ending April 22, 2022:

Click on the text highlighted in colorto access the complete audit report.

State Departments and Agencies 

The New York State Department of Health (DOH) made $965 million in payments to providers, including facilities, for services ordered, prescribed, referred, and attended by practitioners who were not enrolled in the health care program, including those who had been barred due to misconduct, according to an audit released by State Comptroller Thomas P. DiNapoli. Two other audits released found an additional $17 million in overpayments.

“Medicaid is a critically important program, but its payment system is rife with errors,” DiNapoli said. “My auditors found the system was allowing payments on claims involving providers who were not certified to treat Medicaid patients. This not only costs taxpayers, but also allows providers who should be excluded, and may be unqualified, to treat patients. DOH must improve its efforts to fix the shortcomings with its billing system.”

The New York State Medicaid program provides a wide range of medical services to low-income New Yorkers or to those who have special health care needs. For the state Fiscal Year ended March 31, 2021, New York’s Medicaid program had approximately 7.3 million recipients and Medicaid claim costs totaled $68.1 billion.

Auditors found eMedNY, DOH’s Medicaid claims processing system, allowed improper payments for services involving ordering, prescribing, referring, and attending providers who were no longer actively enrolled in the Medicaid program at the time of the service. The improper payments included $5.8 million for services involving providers who were excluded from participating in Medicaid due to past improper behavior or wrongdoing.

The audit covered the period of January 2015 to December 2019. DiNapoli noted DOH made changes to eMedNY in February 2018 which led to a significant drop in the amount of improper payments. However, for the period March 2018 through December 2019, auditors still identified about $45.6 million in claim payments for 135,476 services by ineligible providers.

DiNapoli’s auditors noted that when inactive providers are included on Medicaid claims, DOH lacks assurance those providers can furnish such services, and it increases the risk that excluded, or otherwise unqualified, providers are treating Medicaid enrollees.

DiNapoli recommended DOH:

  • Review the $965 million in payments for Medicaid claims involving inactive providers and determine an appropriate course of action;
  • Enhance controls to prevent improper Medicaid payments for claims that do not report an active provider; and
  • Update guidelines to clarify billing requirements.

Department officials generally agreed with most of the audit recommendations and indicated that certain actions have been and will be taken to address them. DOH’s full response is included in the audit.

A second audit found that from January 2016 through December 2020, DOH potentially overpaid $9.6 million for durable medical equipment, prosthetics, orthotics, and supplies that likely should have been provided by nursing homes as part of the daily all-inclusive rate paid to those facilities.

A third audit covering Medicaid claims processing for the six months ended March 31, 2021 found nearly $7.4 million in improper Medicaid payments, including $3.3 million paid for fee-for-service inpatient claims that should have been paid by managed care or that were also reimbursed by managed care, and $1.5 million paid for inpatient claims that were billed at a higher level of care than what was actually provided. Auditors contacted providers and by the end of the audit fieldwork, about $5.6 million of the improper payments had been recovered.

Audits

Medicaid Program: Improper Payments for Services Related to Ordering, Prescribing, Referring, or Attending Providers No Longer Participating in the Medicaid Program.

Medicaid Program: Improper Medicaid Managed Care Payments for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies on Behalf of Recipients in Nursing Homes.

Medicaid Program: Claims Processing Activity October 1, 2020 Through March 31, 2021.

 School Districts

Delaware-Chenango-Madison-Otsego Board of Cooperative Educational Services (2021M-207) Board of Cooperative Educational Services (BOCES) officials did not properly monitor and account for fixed assets. Thirty-two of the assets tested and valued at $64,300 were not properly accounted for. Auditors found that 28 assets (computers, electrostatic sprayers, nursing beds and other assets) with combined purchase prices of approximately $47,500 did not have required asset tags, were not on the inventory or information technology (IT) inventory asset lists and/or had incorrect or no location noted on the inventory list. A color copier and refrigerator with a combined purchase price of more than $7,200 could not be located. Another two assets (a phone server and a computer) valued at $9,600 were listed in BOCES inventory as active and could not be found.  

 

Lynbrook Union Free School District – Purchasing (Nassau County) The purchasing agent did not ensure purchases adhered to the district’s purchasing policy for goods and services not subject to competitive bidding. As a result, the purchasing agent approved 17 purchases totaling $150,961 without knowing whether the purchases were a prudent and economical use of taxpayer money, and in the district’s best interest.

 

Pelham Union Free School District – Information Technology (Westchester County) District officials did not establish adequate controls over user accounts to help prevent against unauthorized use, access, and loss, and did not adopt an adequate IT contingency plan. In addition to sensitive IT control weaknesses that were communicated confidentially to officials, officials did not periodically review unneeded user accounts and permissions to determine whether they were appropriate or needed to be disabled.

Municipal Audits

Herkimer County Industrial Development Agency – Claims Auditing (2022M-12) Auditors reviewed 100 claims totaling $846,279 and determined they were for appropriate purposes and generally supported by adequate invoices and/or other documentation. However, none of these claims were independently reviewed and approved prior to payment. The board did not appoint someone to audit claims and did not develop and adopt written policies, procedures or other guidance to communicate expectations for the claims audit process.


City of Hornell – Business Improvement District (BID) (Steuben County) The council did not provide sufficient oversight of the BID and the BID Plan lacked sufficient detail to allow city officials to adequately monitor the use of BID funds. The council did not enter into a written agreement with the district management association or monitor how the association used BID funds, resulting in revenues of at least $3,915 that were unaccounted for and 138 questionable disbursements by the association’s executive director totaling $24,955. Based upon audit findings and a subsequent investigation, the executive director of the association was arrested in January 2020 and charged with Grand Larceny in the Fourth Degree and Falsifying Business Records in the First Degree. On January 7, 2022, the executive director pled guilty to Grand Larceny in the Fourth Degree and was ordered to pay $1,711 in restitution.


City of Lackawanna – Garbage Collection Fees (Erie County) City officials did not always assess and bill garbage fees in accordance with the City Code. Officials also did not provide adequate oversight or develop policies and procedures for assessing and billing garbage fees. Of the 33 properties reviewed, 30 were not assessed and/or billed the correct garbage fees in accordance with the code. Twenty-five of these properties were underbilled a total of $6,350. While 16 organizations were billed for garbage services they received, the Code indicates the organizations were not eligible for such services. Of the 27 garbage fee exemptions reviewed, 14 lacked appropriate support and/or did not comply with city requirements.

 

City of Lackawanna – Network Management and Internal Controls (Erie County) City officials did not establish adequate controls to safeguard the network against unauthorized access or disruption. City officials did not regularly review, identify and disable unnecessary network user accounts. As a result, 14 unnecessary generic network user accounts and 26 usernames associated with inactive or former employee accounts were not disabled. City officials have not developed written IT policies and did not provide users with IT security awareness training.

 

Schonowe Volunteer Fire Company, Inc. – Board Oversight (Schenectady County) The board did not develop financial procedures for collections and disbursements, periodically monitor the budget or ensure the constitution was followed. As a result, the company was unable to confirm all money was recorded and deposited intact. Collections totaling $8,956 lacked proper supporting documentation to determine whether they were deposited intact and disbursements totaling $3,052 were not properly supported, audited or authorized before payment.

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Track state and local government spending at Open Book New York. Under State Comptroller DiNapoli’s open data initiative, search millions of state and local government financial records, track state contracts, and find commonly requested data.  



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