Opinion ID: 1315981
Heading Depth: 2
Heading Rank: 1

Heading: Parties and Applicable Regulations

Text: Rubin was the founder and president of Allstate Home Care, Inc. (Allstate), a provider of home health care services with three offices and about 200 employees in Dutchess County, New York. Medicaid paid for services for the majority of Allstate's clients. Medicaid, a program that finances health care for the poor, is jointly funded by the state and federal governments but run by the states individually. See Conn. Dep't of Soc. Servs. v. Leavitt, 428 F.3d 138, 141 (2d Cir.2005). New York's Medicaid program was administered until September 1996 by the New York State Department of Social Services (DSS), and thereafter by the New York State Department of Health. [2] New York State has promulgated detailed regulations that govern Medicaid. One such regulation, concerning payment rates for providers of personal care services that have cost experience (such as Allstate), states: (h) Payment. ... (7) This paragraph sets forth the methodology by which the department will determine MA [medical assistance] payment rates for personal care services providers that have contracts with social services districts for any rate year that begins on or after January 1, 1994. ... (ii) Determination of payment rate. ( a ) Providers with cost experience. ( 1 ) Medical assistance payments to personal care services providers for any rate year beginning on or after January 1, 1994, are made at the lower of the following rates: ( i ) the rate the provider charges the general public for personal care services; or ( ii ) the rate determined by the department in accordance with [a method that accounts for the provider's costs]. N.Y. Comp.Codes R. & Regs. tit. 18, § 505.14(h)(7)(ii)(a)(1). We follow the parties in calling this provision the public charge regulation. The public charge regulation appears in a section of the Medicaid regulations that governs DSS departmental procedures. Another provision, which the parties call the unacceptable practices regulation, states: (b) Conduct included. An unacceptable practice is conduct which constitutes fraud or abuse and includes.... (1) False claims. ( i ) Submitting, or causing to be submitted, a claim or claims for: ... ( d ) amounts substantially in excess of the customary charges or costs to the general public. Id. § 515.2(b)(1)(i)(d). Rubin and Allstate were indicted in March 1998. [3] Rubin was charged with one count of second-degree grand larceny (Count One) and six counts of first-degree filing of a false instrument (Counts Two through Seven), for submitting claims that he falsely certified were in compliance with federal and state laws and regulations; and two more counts of first-degree filing of a false instrument (Counts Eight and Nine), for submitting false cost reports. [4] After Rubin requested a bill of particulars, the state identified two regulations with which it alleged Rubin had falsely certified compliance: the public charge regulation and the unacceptable practices regulation. Rubin was tried before a jury in Supreme Court, Albany County, in March 1999. The case lasted two weeks and featured 22 witnesses.