Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Appellate Division
In the Case of:
Wellington Oaks Care Center,
Petitioner,
- v. -
Health Care Financing Administration.
Decision No. 1626
Docket No. C-96-203
DATE: August 21, 1997
FINAL DECISION ON REVIEW OF
ADMINISTRATIVE LAW JUDGE DECISION
Wellington Oaks, L.P., d/b/a/ Wellington Oaks Care Center (Petitioner)
appealed a January 28, 1997 decision by Administrative Law Judge Jill S.
Clifton dismissing Petitioner's requests for a hearing. See Wellington Oaks
Care Center v. Health Care Financing Administration, DAB CR456 (1997) (ALJ
Decision). There, the ALJ determined that Petitioner had failed to file
timely two separate requests for a hearing and had failed to show good cause
for either untimely filing.
The record in this case consists of the record before the ALJ as well as the
parties' submissions to the Board on appeal of the ALJ Decision. For the
reasons stated below, we conclude that the ALJ Decision should be affirmed.
Therefore, we adopt as final the ALJ Decision, which we attach as an Appendix
to our Decision.
Briefly stated, Petitioner purchased a skilled nursing facility that, both
prior and subsequent to the purchase, had failed compliance reviews by a Texas
State Survey Agency and been placed under the stewardship of a trustee. Based
on those reviews, the Health Care Financing Administration (HCFA) assessed
civil monetary penalties (CMPs) against the facility. A provider such as a
skilled nursing facility has a right to request a hearing on a CMP. Under the
applicable regulations, an ALJ may dismiss a request for hearing if it is not
timely filed and the time for filing has not been extended. 42 C.F.R.
§ 498.70(c). An ALJ may extend the period for filing for good cause shown.
42 C.F.R. § 498.40(c). The ALJ found that Petitioner failed to file both
hearing requests timely and failed to show good cause for extending the time
for filing. She therefore dismissed Petitioner's hearing requests.
The standard of review on a disputed factual issue is whether the ALJ decision
is supported by substantial evidence in the record. The standard of review on
a disputed issue of law is whether the ALJ decision is erroneous.
The ALJ found that: (a) Petitioner was sufficiently aware of the first set
of
CMPs to have discussed them with the trustee prior to the purchase, but did
not request a hearing (Finding 12); (b) Petitioner could be assumed to have
received notice of the second set of CMPs because it never denied receipt
(Finding 26); (c) Petitioner did not file a request for hearing for either set
of CMPs within the period prescribed by regulation (Findings 9 and 30).
Petitioner neither took exception to these Findings nor pointed to any
evidence refuting them. Petitioner's exceptions to other Findings of Fact and
Conclusions of Law were based upon its disagreement with the legal conclusions
drawn from the undisputed facts, rather than any dispute of the facts upon
which the ALJ relied in determining that Petitioner did not show good cause.
Therefore, we reject Petitioner's contention that the ALJ Decision was not
supported by substantial evidence.
As for Petitioner's contentions that the ALJ erred in reaching her legal
conclusions, Petitioner simply reiterated the legal arguments it raised before
the ALJ and maintained that she erred in failing to rule in its favor.
Petitioner did not show that the ALJ's analysis of 42 C.F.R. § 489.18 as
imposing on Petitioner responsibility for timely appeal of the CMPs is
erroneous; it simply argued that the regulation is bad policy. This issue is
beyond the scope of Board review. Petitioner also alleged that the ALJ erred
in concluding that none of the reasons offered by Petitioner constituted good
cause. However, we find that the standard the ALJ applied -- whether the
Petitioner had shown that its requests for hearing were late due to some
intervening force or event beyond its ability to control -- was appropriate
for this particular case. 1/ Petitioner's arguments that it had shown good
cause for its late filings were based on deflecting responsibility for its
delay onto other parties. The ALJ reasonably concluded that --
Petitioner received the HCFA notice letters and made choices: not
to apprise itself timely of the full implications of the remedies;
not to appeal the remedies; and not to follow the instructions in
the notice letters as to where and how to file its hearing
requests.
ALJ Decision at 8.
After having thoroughly considered Petitioner's exceptions, we conclude that
Petitioner did not raise any contentions that were not adequately addressed
by
the ALJ Decision. Accordingly, we affirm and adopt each of the ALJ's Findings
of Fact and Conclusions of Law.
Conclusion
For the reasons stated above, we adopt as a final decision of the Departmental
Appeals Board the ALJ Decision attached as an Appendix to this decision.
_________________________
Judith A. Ballard
_________________________
Cecilia Sparks Ford
_________________________
M. Terry Johnson
Presiding Board Member
* * * Footnotes * * *
1. The ALJ noted that she was not "formulating any
universal rule as to what should constitute good cause in every
case." ALJ Decision at 8.