Health Law Daily State agency, not district court, has exclusive jurisdiction over MaineCare provider termination
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Monday, September 18, 2017

State agency, not district court, has exclusive jurisdiction over MaineCare provider termination

By Jeffrey H. Brochin, J.D.

A state Superior Court erred when it entered summary judgment declaring that the Maine District Court, and not the Maine Department of Health and Human Services (state agency) had exclusive original jurisdiction over the decision to terminate a physician’s provider participation in, and reimbursement from, MaineCare. The Maine Supreme Judicial Court found that a provider’s participation in the state’s Medicaid program does not constitute a "license," and therefore revocation does not invoke state district court jurisdiction (Doane v. Department of Health and Human Services, September 12, 2017, Saufley, L.).

Background. The physician was licensed to practice medicine in Maine by the Board of Licensure in Medicine. The Board censured the physician in March 2015 for: (1) being insufficiently aware of the hazards associated with the opiate medications he was prescribing to a patient who ultimately died of accidental oxycodone and cyclobenzaprine intoxication; (2) failing to follow up on information from other doctors about that patient; and (3) violating a Board rule regarding the use of controlled substances for pain treatment. The Board renewed his license, but imposed terms of probation and required him to pay $12,000 to the Board for the costs of investigation and enforcement.

In a letter, the state agency informed the physician that it had decided to terminate his participation in, or reimbursement from, the MaineCare program. The letter said that the state agency was acting pursuant to the MaineCare Benefits Manual and the authority granted by the federal government via 42 C.F.R. Part 1002. He requested informal review, after which the state agency affirmed the initial decision terminating his participation in MaineCare.

Declaratory judgment proceedings. The physician filed a complaint in the Superior Court seeking declaratory judgment that the state agency’s decision terminating his participation in MaineCare constituted a "license revocation"—a decision over which the District Court had exclusive original jurisdiction under 4 M.R.S. Sec. 152 (9) and 5 M.R.S. Sec. 8002 (5), and enjoining the administrative termination proceeding. The court granted summary judgment for the physician after concluding that the ability to provide and be reimbursed for MaineCare treatment fell within the statutory definition of a "license."

District Court jurisdiction. The Maine Supreme Judicial Court noted that a physician’s authority to practice medicine in Maine is through the issuance of a license from the Board of Licensure in Medicine. The issue before the court was whether the capacity to participate in MaineCare is also a "license," the revocation of which the legislature intended to place within the jurisdiction of the District Court.

State agency authority. The court found that in exercising Maine’s authority to exclude individuals or entities from participating in the MaineCare program, the state agency may impose sanctions on a provider. Furthermore, the state’s regulations explicitly vested in the state agency commissioner the responsibility to decide to impose sanctions within the MaineCare program, including whether to continue a physician’s participation in the program as set forth in the provider agreement.

Based on the foregoing, the court construed the statutes as not conferring on the District Court jurisdiction over the imposition of a sanction on a MaineCare provider by the state agency. Therefore, the agency’s decision to terminate the physician’s MaineCare participation did not fall within the licensing decisions over which the legislature gave the District Court original and exclusive jurisdiction. Accordingly, the court vacated summary judgment and remanded the matter.

The case is No. 2017 ME 193.

Attorneys: Christopher C. Taintor (Norman, Hanson & DeTroy, LLC) for Stephen Doane. Janet T. Mills, Office of the Maine Attorney General, for Maine Department of Health and Human Services.

Companies: Maine Department of Health and Human Services

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