Opinion ID: 1403143
Heading Depth: 3
Heading Rank: 1

Heading: The Division's First Action

Text: The first of these actions came in 1992, when the Division sought to sanction McConnell for violations of several provisions of chapter 43, title 7 of the Alaska Administrative Code (AAC). [2] The Division alleged a number of problem areas that warranted sanctions; these centered around McConnell's documentation and billing practices. Because of these violations, the Division decided to suspend McConnell from the Medicaid program for three months and to require McConnell to reimburse it for $89,645 in overpayments. This amount was later increased to $113,917.58. McConnell appealed this decision. While this appeal was pending, McConnell and the Division entered into a settlement and release agreement. This settlement is dated September 16, 1993 and provides that: 1. Dr. McConnell will pay to the Division... [$60,000] as consideration for the [Division's] release and discharge of all ... claims against Dr. McConnell for reimbursement of any past medical fees paid to Dr. McConnell by the Division ... for the audit period May 23, 1991 through March 31, 1992.... .... This Settlement Agreement is not applicable to the period before May 23, 1991 and after March 31, 1992.... 2. Dr. McConnell agrees to attend a Provider Education Session.... .... 5. The Division ... understands and acknowledges that this settlement is in compromise of a disputed claim and that Dr. McConnell's payment of $60,000 and Dr. McConnell's agreement to attend a Provider Education Session is not to be construed as an admission of liability on the part of Dr. McConnell by whom liability is expressly denied. .... 7. This Settlement and Release agreement contains the entire agreement between the parties hereto and the terms of the release are contractual and not merely a recital. The consideration for this Settlement and Release is the dollar amount to be paid by Dr. McConnell and Dr. McConnell's agreement to attend provider education. On October 5, 1993, the Division requested five patient files from McConnell to help it prepare for the provider education that was part of the settlement. This letter was signed by Eric S. Hansen, Chief of the Division of Medical Assistance. McConnell provided the requested files, which the Division forwarded to three physicians: Drs. Martino, Winn, and McCarthy. The cover letters to two of the physicians are part of the record on appeal. According to both letters, the files were being provided to the physicians for the purpose of helping the Division craft an appropriate provider education session for McConnell. The letter to Dr. Martino begins: Under the settlement agreement between Dr. McConnell and the State, Dr. McConnell agreed to participate in provider education. Similarly, the letter to Dr. Winn states: The above files are to be reviewed in preparation for providing Dr. McConnell with provider education. The Division did not state that sanctions could arise from its review of these files in either the letters to McConnell or the letters to the reviewing physicians. On January 31, 1994, Hansen sent a letter to McConnell stating that: Pursuant to the settlement agreement you agreed to the sanction of provider education. In preparation for this provider education we have reviewed a sample of your patient charts and billings for Medicaid patients that were admitted and discharged from May through June 1993. This is to advise you of our finding that you are in technical compliance with the specifics of our earlier letters regarding use of codes in billing the Medicaid program. As those letters ... have apparently served adequately as provider education, it will not be necessary to have a face-to-face education session for our purposes. Accordingly, we consider our previous letters to be the provider education sanction to which you agreed. If you would still like to schedule a meeting for yourself or your billing people to review this information, we will be available at your convenience. Please note that we are continuing to review your patient records and will contact you soon regarding our complete findings.