Oxenhorn v. Fleet Trust Co., 722 N.E.2d 492 (NY 1999). · Go Syfert
Oxenhorn v. Fleet Trust Co., 722 N.E.2d 492 (NY 1999). Cases Citing This Book View Copy Cite
16 citation events (15 in the last 25 years) across 3 distinct courts.
Strongest positive: Stern v. Sullum (nyappdiv, 2022-03-31)
Top citers, strongest first. 11 distinct citers. How cited ↗
discussed Cited as authority (rule) Stern v. Sullum
N.Y. App. Div. · 2022 · confidence medium
The original infant compromise order may have impeded full reimbursement to the State for the sums it has expended and will expend on Tara's care, as the special needs trust may not contain sufficient funds for reimbursement ( see Oxenhorn v Fleet Trust Co. , 94 NY2d 110, 114 [1999]; see generally Matter of Abraham XX. , 11 NY3d 429, 434-435 [2008] [special needs trust, which is exempt from consideration for Medicaid eligibility purposes, must contain a payback provision so that upon the death of the Medicaid recipient, any balance left in the trust must be paid back to the State in an amount …
discussed Cited as authority (rule) New York City Hous. Auth. v. Oakman
N.Y. App. Div. · 2020 · confidence medium
Finally, even if plaintiff erroneously continued to make housing assistance payments to defendant at a time when it knew that he was ineligible to receive them, a mistake does not estop a governmental entity from correcting errors ( see Oxenhorn v Fleet Trust Co., 94 NY2d 110, 116 [1999]).
discussed Cited as authority (rule) People ex rel. Johnson v. Superintendent, Fishkill Correctional Facility
N.Y. Sup. Ct. · 2015 · confidence medium
(Oxenhorn v Fleet Trust Co., 94 NY2d 110, 116 [1999]; Matter of Parkview Assoc, v City of New York, 71 NY2d 274, 282 [1988]; Morley v Arricale, 66 NY2d 665, 667 [1985].) This does not suggest that the Department’s prior policy of placing level three sex offenders at the Bellevue shelter is irrelevant.
discussed Cited as authority (rule) Foote v. Albany Medical Center Hospital
N.Y. App. Div. · 2009 · confidence medium
This would be so because Medicaid is a payor of last resort (see 42 USC § 1396k [a] [1] [C]; § 1396a [a] [25] [H]; Social Services Law § 367-a [2] [b]; Oxenhorn v Fleet Trust Co., 94 NY2d 110, 114 [1999]) and “[Recoupment from responsible third parties is necessary to ensure that the Medicaid program remain[s] ‘ “the payor of last resort” ’ ” (Cricchio v Pennisi, 90 NY2d 296, 305 [1997] [citation omitted])..
discussed Cited as authority (rule) Delaware County Department of Social Services v. Pontonero
N.Y. App. Div. · 2006 · confidence medium
Plaintiff’s right to recover payment of Medicaid benefits is conferred by statute (see Social Services Law §§ 104, 106-b), and the statutory scheme contemplates that, when needed, benefits such as those paid for Pontonero’s residential nursing care are to be provided as speedily as possible, with further investigation and possible liability for reimbursement determined later on (see Oxenhorn v Fleet Trust Co., 94 NY2d 110, 116-117 [1999]).
discussed Cited as authority (rule) Rice v. Novello
N.Y. App. Div. · 2006 · confidence medium
Inasmuch as Medicaid is considered the payor of last resort and all other available resources must be used before Medicaid (see Oxenhorn v Fleet Trust Co., 94 NY2d 110, 114 [1999]; Matter of Commissioner of Social Servs. of Franklin County v Bernard B., 87 NY2d 61, 68 [1995]), decedent’s application for Medicaid benefits required DSS to determine the nature of the trust (see 18 NYCRR 360-4.5).
discussed Cited "see" Matter of Whitfield v. Annucci
N.Y. App. Div. · 2018 · signal: see · confidence high
Despite the fact that petitioner's parole notices erroneously indicated that he was eligible for CRD, DOCCS is not estopped from correcting such error in order to comply with its statutory authority ( see Correction Law § 700 [1] [a]; [2] [b]; see generally Oxenhorn v Fleet Trust Co. , 94 NY2d 110, 116 [1999]).
cited Cited "see" Bilow v. Daines
N.Y. App. Div. · 2010 · signal: see · confidence high
Transporters Assn. v Perales, 77 NY2d 126, 130 [1990]; see Oxenhorn v Fleet Trust Co., 94 NY2d 110, 116 [1999]).
discussed Cited "see" In re Swingearn
N.Y. App. Div. · 2009 · signal: see · confidence high
The right of DSS to recover payment of Medicaid benefits is conferred by statute (see Social Services Law §§ 104, 106-b), and “the statutory scheme contemplates that, when needed, benefits such as those paid for [the incapacitated person’s] residential nursing care are to be provided as speedily as possible, with further investigation and possible liability for reimbursement determined later on” (Delaware County Dept, of Social Servs. v Pontonero, 31 AD3d 999, 1000 [2006]; see Oxenhorn v Fleet Trust Co., 94 NY2d 110, 116-117 [1999]).
examined Cited "see" Nededog v. Colorado Department of Health Care Policy & Financing (3×)
Colo. Ct. App. · 2004 · signal: see · confidence high
See Oxenhorn v. Fleet Trust Co., 94 N.Y.2d 110 , 700 N.Y.S.2d 413 , 722 N.E.2d 492 (1999).
cited Cited "see" Whittum v. New York State Department of Health
N.Y. App. Div. · 2002 · signal: see · confidence high
State Dept. of Health, 283 AD2d 645 ; 18 NYCRR subparts 360-2, 360-4; EPTL 7-3.1 [c]; see generally Oxenhorn v Fleet Trust Co., 94 NY2d 110 ).
Retrieving the full opinion text from the archive…
Mitchel Oxenhorn, as Commissioner of the Department of Social Services of the County of Columbia, Appellant,
v.
Fleet Trust Company, Formerly Known as Norstar Trust Company, Defendant, and Estate of Marion F. Judson Et Al., Respondents
New York Court of Appeals.
Nov 18, 1999.
722 N.E.2d 492
POINTS OF COUNSEL, Connor, Curran & Schram, P. C., Hudson (Paul M. Freeman of counsel), for appellant., Herzog, Engstrom & Koplovitz, P. C., Albany (Frank W. Lang of counsel), for respondents., Eliot Spitzer, Attorney General, Albany (Preeta D. Bansal, Peter H. Schiff and Kathleen M. Treasure of counsel), for New York State Department of Health, amicus curiae.
Wesley.
Cited by 13 opinions  |  Published

OPINION OF THE COURT

Wesley, J.

Plaintiff, Commissioner of the Department of Social Services for Columbia County, seeks to recover Medicaid benefits paid to decedent Marion F. Judson, the named beneficiary of a self-settled, irrevocable trust. The parties acknowledge that had the Department included the trust principal in its eligibility determination, decedent would not have been eligible for Medicaid benefits. Defendants contend, however, that because the Department made an administrative error that was not due to misrepresentation or fraud, the benefits should be deemed “correctly paid” to decedent within the meaning of Social Services Law § 369 (2) (b) (i) and are therefore not recoverable. We disagree, reverse the order of the Appellate Division and reinstate the order of Supreme Court.

I.

Marion Judson resided in a nursing home from May 1, 1989 until her death on December 26, 1995. She initially was admitted as a private-pay resident. On May 1, 1991 one of her sons submitted an application for Medicaid benefits on her behalf to the Columbia County Department of Social Services. The ap[*113] plication disclosed that Judson was the named beneficiary of a self-settled, irrevocable trust; a copy of the trust instrument was provided. The trust instrument stipulated that the trustee was to pay decedent the trust income and gave the trustee discretion to apply “all or such part of the principal of this trust * * * for the support, care and maintenance of [decedent] during [her] lifetime.” The initial application was denied.

A second application, submitted on September 4, 1991, also contained the trust information. This time, the Department determined that Judson was eligible for Medicaid benefits. The Department included the trust income in determining her eligibility for Medicaid, but did not include the trust principal as an available resource, as it should have been. The parties do not dispute that decedent would not have been eligible for benefits if the trust principal were taken into account. From October 1991 until December 26, 1995, all income from the trust was paid directly to the Department. During this time, Judson received Medicaid benefits totaling $121,302.97 for nursing home care. At the time of her death, the trust principal was approximately $150,000.

The Department commenced this action against the trustee and decedent’s sons as co-executors of her estate. (Decedent’s sons are also sole beneficiaries of the trust.) On three separate theories, the Department sought reimbursement for the funds it expended for Judson’s care. The first cause of action against all defendants was based on a section of the Social Services regulations (18 NYCRR 360-4.5) that allows County Social Service Departments to consider the corpus of certain Medicaid-qualifying trusts in eligibility determinations. The second cause of action against only the co-executors was premised on a theory that they breached their fiduciary duty in failing to obtain payment of decedent’s debts (including the incorrect Medicaid payments) from the trust corpus. The third cause of action, brought against the trustee and the co-executors, alleged a cause of action under Social Services Law § 369 (3). In this claim, the Department asserted that it could reach the trust corpus because decedent had a “beneficial interest” in the trust corpus at the time she received Medicaid benefits.

Following joinder of issue, the Department and all defendants separately moved for summary judgment. The court granted partial summary judgment to the Department on its third cause of action on liability only. The court held that the Medicaid payments were incorrectly paid and relied on Social Services Law § 369 (3) to conclude that the Department was[*114] entitled to recover the payments from the trustee. The court ordered further discovery on the amount due the County.

The Department and the co-executors cross-appealed, although the trustee did not. With regard to the third cause of action, the Appellate Division held that the benefits at issue were “correctly paid” pursuant to Social Services Law § 369 (2) (b) (i) and that the Department was therefore precluded from recovering the payments under Social Services Law § 369 (3). The court relied on Matter of Akullian (167 AD2d 596) to support its determination, reasoning that because there was no claim of fraud or misrepresentation in the application process, the benefits were “correctly paid.” The court also dismissed the first two causes of action. The court noted that the regulation in question did not create a right of recovery after an eligibility determination and that with regard to the second cause of action, the Department would have an opportunity to press its claims in Surrogate’s Court. We granted leave to appeal and now reverse and reinstate the order of Supreme Court. [1]

II.

Medicaid is a jointly funded Federal and State program that pays for necessary medical care for the indigent (see, 42 USC § 1396 et seq.; Social Services Law § 363 et seq.; Calvanese v Calvanese, 93 NY2d 111, 116). The Medicaid program is intended to be the “payor of last resort” — all other available resources must be used before Medicaid (S Rep No. 146, 99th Cong, 2d Sess 1, 312, reprinted in 1986 US Code Cong & Admin News 42, 279).

The Legislature has enacted a series of “recovery statutes” that define the terms under which the State can recoup Medicaid payments from recipients. One of these statutes, Social Services Law § 369 (2) (b) (i), states:

“Notwithstanding any inconsistent provision of this chapter or other law, no adjustment or recovery may be made against the property of any individual on account of any medical assistance correctly [*115] paid to or on behalf of an individual under this title, except that recoveries must be pursued:
“(A) upon the sale of the property subject to a lien imposed on account of medical assistance paid to an individual * * * or from the estate of such individual; and
“(B) from the estate of an individual who was fifty-five years of age or older when he or she received such assistance” (emphasis added).

Thus, the statute limits a Department’s ability to recover benefit payments when those payments were “correctly” made.

Section 369 (2) (b) (i) does not define “correctly paid.” However, Social Services Law § 106-b, entitled “Adjustment for Incorrect Payments,” provides:

“[A] social services official shall * * * take all necessary steps to correct any overpayment * * * to a public assistance recipient * * * For purposes of this section, overpayment shall include payments made to an eligible person in excess of his needs as defined in this chapter and payments made to ineligible persons” (emphasis added).

In determining that the Medicaid benefits at issue here were “correctly paid” pursuant to section 369 (2) (b) (i), the Appellate Division relied on Matter of Akullian (167 AD2d 596, supra). In that case the Delaware County Department of Social Services approved decedent’s application for Medicaid benefits and paid more than $22,000 to him in the year prior to his death, despite the Department’s knowledge that within the two-year period preceding his Medicaid application, two court orders — one authorizing the transfer of decedent’s assets and one granting a divorce — were obtained in an attempt to qualify him for medical assistance. The Department attempted to recover the Medicaid payments from his estate, arguing that the benefits were incorrectly paid pursuant to Social Services Law §369.

The Appellate Division concluded that because the Department had found Judson eligible for Medicaid and did not identify any fraud or misrepresentation in the application process, the benefits were “correctly paid” (id., at 597). The court noted that while the Department was aware of the transfers, it failed to raise any concerns, although it was required by law to determine an applicant’s eligibility for medical assistance.

[*116] Defendants embrace Akullian and argue that the Department’s approval of Judson’s application confirms that the benefits were “correctly paid.” They contend that the Department received full and fair disclosure of the terms of the applicant’s trust and that there was no fraud or misrepresentation in the application process. Thus, they assert, the Department may not now claim that the benefits at issue were incorrectly paid.

We disagree with defendant’s position and theory. Akullian imparted a condition for the recovery of Medicaid benefits that has no basis in the statutory language. The pertinent statutes do not require a finding of fraud or misrepresentation to conclude that benefits are incorrectly paid. Furthermore, we have long recognized that a mistake does not estop a government entity from correcting errors (Matter of Parkview Assocs. v City of New York, 71 NY2d 274, 282; Morley v Arricale, 66 NY2d 665, 667). One employee’s mistake cannot irreversibly chart the course of the Department’s responsibilities in this regard.

The statutory scheme requires Department officials to “take all necessary steps to correct any overpayment” (Social Services Law § 106-b). Overpayment includes payments made in excess of one’s needs or “payments made to ineligible persons” (id. [emphasis supplied]). Because the Department did not include the trust principal in its eligibility calculation, it paid benefits to an ineligible individual (see also, Matter of Rummer, 93 AD2d 135, 177-181; Matter of Galcia, 59 Misc 2d 511; Matter of Gonzalez, 154 Mise 2d 633). Furthermore, overpaid benefits are not deemed “correctly paid” when they are not paid in accordance with lawful authorization. Thus, the limitations of Social Services Law § 369 (2) (b) (i), on an agency’s ability to recover benefits “correctly paid,” are not applicable here. [2]

Our conclusion is consistent with similar provisions under the Federal Medicaid Act. Unlike the statutory language of other Federal assistance programs (see, e.g., 38 USC § 5302 [c] [Veterans’ Benefits]; 42 USC § 404 [Social Security]; 42 USC § 1383 [b] [1] [B] [Social Security Supplemental Income]; 45 USC § 23li [c] [Retirement of Railroad Employees]), the[*117] Federal Medicaid statute does not limit the right to recover benefits to those paid only as a result of fraud or misrepresentation. Thus, courts can reasonably infer that Congress intended to permit recovery of benefits even from those who mistakenly received them, regardless of fault for the source of the error.

Finally, our holding is consistent with the policy underlying the Medicaid program: to provide funds to indigent individuals as the “payor of last resort” (see, Matter of Golf v New York State Dept. of Social Servs., 91 NY2d 656, 659). To adopt defendants’ rationale would circumvent that well-founded policy.

Accordingly, the order of the Appellate Division should be reversed, with costs, and the order of Supreme Court should be reinstated.

Chief Judge Kaye and Judges Bellacosa, Smith, Levine, Ciparick and Rosenblatt concur.

Order reversed, etc.

1

. Even though the trustee did not appeal to the Appellate Division (see, Merritt Hill Vineyards v Windy Hgts. Vineyard, 61 NY2d 106), that court effectively vacated Supreme Court’s decision concerning the trustee by determining that Social Services Law § 369 (3) did not apply when Medicaid benefits were “correctly paid” pursuant to Social Services Law § 369 (2) (b) (i). We therefore treat the Appellate Division order, as do the parties, as reversing the Supreme Court order with regard to the trust.

2

. Defendants do not contest the Department’s ability to recover against the trust if the limitations of section 369 (2) (b) (i) do not come into play. Thus, we do not reach the issue whether decedent — the trust beneficiary— retained a “beneficial interest” in the trust as defined by Social Services Law § 369 (3) after her death or if that interest terminated with her death.