Opinion ID: 1403143
Heading Depth: 3
Heading Rank: 2

Heading: The Division's Second Action

Text: Despite these letters, the Division's next communication with McConnell was to inform him that the Division was sanctioning him for violations of 7 AAC 43.950(5) [3] and (46). [4] In this letter, sent on July 6, 1994, Director Kimberly Busch wrote McConnell: In preparing for your provider education, [we] conducted a review of your recent billing and charting practices for Medicaid patients..... While you may or may not be in technical compliance with the limits imposed for billing under certain CPT [5] procedure codes as set forth in our previous letters..., we have some serious concerns about your chart notes and overall billing patterns. These alleged violations were discovered by the three doctors mentioned above during their review of the five files that McConnell had provided the Division. Based on these findings, the Division decided to suspend McConnell from the Medicaid program for six months. McConnell appealed this decision. The matter was heard before a Division hearing officer, Robert Landau, over twenty-seven days, from May 22 to November 20, 1995. In a thoughtful and thorough 50-page decision, the hearing officer concluded that McConnell could not be sanctioned under 7 AAC 43.950(5) because the quality of the services McConnell had provided had not been adjudged by a body of professional peers, as that section requires. However, the hearing officer decided that McConnell could be sanctioned under 7 AAC 43.950(46) because McConnell's records were not accuratethat is, they did not conform to a nationally recognized standard such as the CPT. Specifically, the hearing officer found that many of Dr. McConnell's brief rounding notes do not meet [the CPT] standard because they fail to document either a problem focused history or a problem focused examination. Taking the relevant factors regarding the proper sanction into account as specified in 7 AAC 43.960, the hearing officer decided that a six-month suspension would not be warranted and that provider education is the most appropriate sanction. In view of Dr. McConnell's acknowledged compliance with previous Division instructions; the Division's previous failure to follow through with provider education; the lack of any established record of prior violations or sanctions; and the absence of any evidence of harm arising from Dr. McConnell's charting, the weight of the evidence supports a sanction that is remedial rather than punitive. Director Bob Labbe, who had replaced Kimberly Busch, accepted the hearing officer's findings of fact, conclusions of law, and proposed decision. McConnell, however, appealed the decision to the superior court, which affirmed the hearing officer's decision. This appeal followed.