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In the Matter of Eric J. Koch, D.O v. James G. Sheehan

March 23, 2012

IN THE MATTER OF ERIC J. KOCH, D.O., PETITIONER-RESPONDENT,
v.
JAMES G. SHEEHAN, NEW YORK STATE MEDICAID INSPECTOR GENERAL, RESPONDENT-APPELLANT.



Appeal from a judgment (denominated order and judgment) of the Supreme Court, Erie County (Diane Y. Devlin, J.), entered August 24, 2010 in a proceeding pursuant to CPLR article 78.

The opinion of the court was delivered by: Martoche, J., J.

Matter of Matter of Koch v Sheehan

Appellate Division, Fourth Department

Decided on March 23, 2012

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This opinion is uncorrected and subject to revision before publication in the Official Reports.

PRESENT: SCUDDER, P.J., CENTRA, PERADOTTO, LINDLEY, AND MARTOCHE, JJ.

OPINION AND

The judgment granted the petition.

It is hereby ORDERED that the judgment so appealed from is unanimously affirmed without costs.

Opinion by Martoche, J.:

Respondent, the New York State Medicaid Inspector General, appeals from a judgment granting the CPLR article 78 petition, thereby vacating respondent's determination excluding petitioner from participating in the New York State Medicaid Program and reinstating petitioner retroactively to March 10, 2010 as a participating physician in the Medicaid Program. We are called upon to consider for the first time the scope of the authority of the Office of the Medicaid Inspector General (OMIG) insofar as it relates to physician conduct not involving Medicaid patients.

OMIG

The Department of Health (DOH) is the state agency responsible for administering the state's Medicaid Program (see Social Services Law § 363-a; 18 NYCRR 504.1 [d] [12]). Within the DOH, the OMIG was established in 2006 as an independent entity responsible for detecting and preventing fraud, waste, and abuse in the Medicaid Program (Public Health Law §§ 30, 30-a, 31, 32). Among other things, respondent is authorized to exclude enrolled health care providers from the Medicaid Program (see § 32 [6]), and to "perform any other functions that ...


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