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A CRUCIAL DOCUMENT SUBMITTED TO PROVE THE AMOUNT OF A MEDICAID LIEN SHOULD NOT HAVE BEEN ADMITTED AS A BUSINESS RECORD; THE DOCUMENT WAS NOT CERTIFIED BY AN EMPLOYEE FAMILIAR WITH THE BUSINESS PRACTICES OF THE ENTITY WHICH PROVIDED THE DATA COLLECTED IN THE DOCUMENT (FOURTH DEPT).

The Fourth Department, reversing Supreme Court, determined a crucial document needed to determine the amount of a Medicaid lien should not have been admitted as a business record pursuant to CPLR 4518 and 2307. The Department of Social Services (DSS) introduced a State Department of Health (SDOH) document, a claim detail report (CDR), which collected data provided by another entity (CSRA), but the certification was not by a person familiar with the business and record-keeping practices of CSRA:

DSS sought to lay the requisite foundation for admission of the CDR as a business record by way of the certification of an SDOH employee (see CPLR 2307, 4518 [c]). The certification stated, in relevant part, “that the annexed [CDR] is a true and accurate copy of the original [CDR], which was generated from data contained in the Adjudicated Claim File. The Adjudicated Claim File, a comprehensive computer data file, is created, maintained and transported in the form of magnetic media to the [SDOH] by CSRA, Inc. [(CSRA)], a fiscal intermediary which contracts with the [SDOH].” Thus, the certification clearly states that the data sought to be admitted in evidence via the CDR was “created” and “maintained” by CSRA, a third-party entity. The SDOH employee who certified the CDR did not, however, work for CSRA, i.e., the entrant of the information upon which the CDR is based. Further, although the certification stated that the CDR was “produced” in the regular course of SDOH’s business and that the data entries were “transported” to SDOH “at or about the time that such data [was] received and incorporated into the Adjudicated Claim File,” the SDOH employee did not establish that CSRA, as “entrant[,] was under a business duty to obtain and record the” data reflected in the Adjudicated Claim File … , or that he was familiar with the record-keeping practices of CSRA and that SDOH generally relied upon CSRA’s records … . At best, the certification demonstrated only that SDOH filed and retained the data created and maintained by CSRA, which fails to establish the requisite foundation … . Matter of Joseph M.W. (Blake), 2020 NY Slip Op 06583, Fourth Dept 11-13-20

 

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Insurance Company’s Documents Protected by Attorney-Client Privilege/Where there is a Discrepancy Between an Order and the Related Decision, the Decision Controls

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