Legal (Deposition) Transcription
P R O C E E D I N G S
BY MR. GLICK:
Q.
Okay.
(Cont'g.)
Dr. Heiner, I’ll show you Exhibit R, prior affidavit was
signed in 1994, could you please take a look at that?
and review the -- your affidavit.
Please take your time
Have you read it, Dr. Heiner?
A.
Yes.
Q.
Is there -- is there anything in this particular affidavit that
wouldn't be applicable today, in this particular audit?
A.
Well, this was an audit done by HCFA, Health Care Finance
Administration, which you'd think would refer to Medicare or Medicaid but it
looks like it's referring to AFTC program.
be.
So, I’m wondering why that might
It's probably because at this point in time, all federal money had to
pass through the same state agency, which was the Department of Social
Services at the time.
Q.
So, it must have a similar thing down in Washington.
Yeah, with respect to this, the statistical sampling
extrapolation, the language used in this particular affidavit, many things
here -- is everything here applicable today for this particular audit?
A.
Yeah, unless you get into the specifics.
Q.
I'm just asking general.
A.
Yeah, in generals that's the same sort of idea.
Q.
Okay, thank you.
you Exhibit S.
Can I have it back, please?
Doctor, I’ll show
Please take a look at it before I ask you more questions,
specifically referring to paragraph twelve of your affidavit of December
10th, 1994.
A.
Yes.
Q.
Do you see paragraph twelve?
A.
Yes.
Q.
In this particular case, in this particular matter, was there a
seed preserved?
A.
No, no.
Q.
Does the absence of a seed fail in that particular case?
A.
No, because it had -- they provided me with the numbers.
I could
have -- I could have tested it.
Q.
And you -- you had the numbers in this particular case --
A.
Yes.
Q.
-- for this particular, is that correct?
A.
Yes.
Q.
Okay.
Can I have it back, please?
Returning Exhibit F to the
court.
MR. GLICK:
A few more questions.
A.L.J. MULVEY:
BY MR. GLICK:
Q.
Okay.
(Cont'g.)
Okay, Dr. Heiner, a few more questions.
free statements.
You have been -- well,
You'd been present throughout these proceedings.
heard all the testimony of all the witness.
You've
I'm specifically referring to
Dr. Maycuth and Dr. Haller, is that correct?
A.
Those witnesses, yes.
Q.
Okay.
And Dr. Heiner, you've testified extensively on cross
examination today, and I think two or three days prior, is that correct?
A.
Yes.
Q.
Okay.
One question and that's it.
Dr. Heiner, knowing now what
you know about this particular audit, all that you've heard from all the
provider’s experts, do you still certify that the sampling and extrapolation
methodology used by the OMIG in this audit is a statistically valid
methodology?
A.
Yes.
MR. GLICK:
I have no further question.
A.L.J. MULVEY:
MR. SHERRIN:
Okay.
I have no questions.
A.L.J. MULVEY:
Okay.
All right, thank you Mr. -- Dr. Heiner, I
think you're done.
MR. SHERRIN:
MR. GLICK:
Thank you.
Thank you doctor.
THE WITNESS:
Thank you.
MR. SHERRIN:
Are you going to miss us?
THE WITNESS:
I am, but I might see you again.
A.L.J. MULVEY:
Okay, off the record.
(Off the record)
(On the record)
A.L.J. MULVEY:
Okay.
We are back on the record in the matter of
UCP Association of Putnam and Southern Dutchess, also known as Hudson
Valley.
Mr. Glick, do you have any witness?
MR. GLICK:
Yes, I do Your Honor, a Mr. Kevin Ryan, from the
OMIG.
A.L.J. MULVEY:
Okay.
Mr. Ryan, *00:07:13 get sworn in by the
court reporter.
THE REPORTER:
Could you raise your right hand please?
Do you
swear or affirm the testimony you are about to give today is the truth,
the whole truth and nothing but the truth?
MR. RYAN:
I do.
MR. KEVIN RYAN; Sworn
THE REPORTER:
THE WITNESS:
And please state your full name for the record?
Kevin Patrick Ryan.
THE REPORTER:
MR. GLICK:
Thank you.
May I voir dire Your Honor?
A.L.J. MULVEY:
Yes.
VOIR DIRE EXAMINATION
BY MR. GLICK:
Q.
Good afternoon, Mr. Ryan.
A.
Yeah.
Q.
You are obviously away here today to provide testimony with
respect to OMIG audit number thirteen, fifty-two ADA of UCP Putnam, is that
correct?
A.
Correct.
Q.
Okay.
Just to remind you, please keep your voice up so we can
take down everything you say by way of the microphone, and please don't nod
or shake your head.
Please verbally respond to the question.
A.
Understood.
Q.
Okay.
And please talk slowly and carefully in response to any of
my questions or Mr. Sherrin’s question.
If you don't understand one of them,
please ask us to repeat it, we'll be happy to do that, clear?
A.
Understood.
Q.
Okay.
Before we get into the Putnam audit, I'd like to ask you
some preliminary background questions, if that’s okay?
A.
Okay.
Q.
Mr. Ryan, please tell us what if any colleges or universities
that you attend?
A.
I attended State University of New York at Albany.
Q.
And when did you graduate?
A.
1981.
Q.
And what type of degree -- degree did you attain?
A.
A bachelor’s degree.
Q.
Okay.
A.
I did not.
Q.
Okay.
And did you do any postgraduate training work?
Could you please tell us your employment history starting
with New York State?
A.
I started with New York State in March of 1988, first department
was Social Services.
Q.
Is that DSS?
A.
That's DSS.
Q.
When you got to DSS, what did you do?
A.
I worked on Medicaid related programs basically attempting to
maximize the federal reimbursement for New York State Medicaid.
Q.
And how long were you at DSS?
A.
Approximately ten years.
Q.
And what -- do you have a specific job classification and
designation while you were there?
A.
My civil service title was Management Specialist.
Q.
Okay.
And after your tenure with the DSS Department of Social
Services, what happened next with respect to your New York State employment?
A.
Department of Social Services was broken up into several
different agencies.
Q.
Okay.
My function was transferred to the Department of Health.
When you got to the Department of Health, when was that
approximately?
A.
That was approximately in 1998.
Q.
In 1998, what are your duties and responsibilities with the
Department of Health?
A.
My duties -- because of the change in department, my duties
didn't really change.
I was still working on in Medicaid related activities.
As we morphed into the Department of Health, I get into more data analytics
using our data mart and our data warehouse.
Q.
Okay.
Before you go on, you mentioned that you did Medicaid
related activities while at DOH, could you tell us with detail what that
means, what you did?
A.
Well, obviously Medicaid used very expensive program.
many facets to it.
There’s eligibility to provide re-enrolment.
there’s investigation, there's data analytics.
There's
There’s RX,
And again, a part of that was
to maximize the amount of a federal reimbursement that we would we get.
We -
- the state pays part, feds pay part and part of my job was to try to
maximize that reimbursement.
Again as I got into the Department of Health,
the technology became available that allowed us to access a data mart and/or
a data warehouse so that we could have access to all the Medicaid information
at our desktops.
Q.
What does that mean data mart, data warehouse?
A.
These are repositories of Medicaid claims and related
information.
Q.
Okay.
And how long were you at the DOH?
A.
Again approximately ten years.
Q.
And DOH, then you went to OMIG, am I correct?
A.
Well, then OMIG was created and the program integrity -- Medicaid
Program Integrity function was transferred from the Department of Health into
Medicaid Inspector General.
Q.
Do you recall approximately when that was?
A.
I believe that was around 2006.
Q.
Okay.
So when you got the office of Medicaid Inspector General
or I’m going to say OMIG from now on, what were your duties and
responsibilities?
A.
It continued to be data-related, to the Medicaid program.
I
would do data analytics, prepare extracts, do analysis for various units
within OMIG.
We began to do our own audit samples which would necessitate
the extraction of data universes, and you know preparing audit packages and
things like that.
There was a lot of different data analytics that we
performed.
Q.
the OMIG?
And were you given any particular or designated training order at
A.
We had various Microsoft trainings.
We had data warehouse
trainings, just office type related trainings.
Q.
What was your job classification and designations while you're at
A.
Again, I was within the management specialist series of -- I
OMIG?
think I -- I got a promotion.
Q.
When were you promoted?
A.
I got one promotion I believe in 1994, and another round 2002.
Q.
And do you have any subsequent promotions since 2002?
A.
Yeah, in 2013 I was promoted to my current title of Deputy
Medicaid Inspector General.
Q.
As Deputy Medicaid Inspector General, what are your job duties
and functions?
A.
I have responsibility for the division of system utilization and
review, that encompasses three separate bureaus, one of which is Third Party
Liability Bureau, one of which is -Q.
What -- excuse me, what does the Third Party Liability Bureau
A.
Medicaid is -- is a public pay function and it should be the
did?
payer of last resort.
So the third party unit looks to make sure that we
have commercial insurance information on any of the Medicaid recipients, so
that the commercial insurance can be built first before Medicaid pays.
So,
there is various functions that go along with that but the identification of
commercial insurance and the recovery of any expenditures paid by Medicaid
which should have been paid by a commercial insurance are all part of that
unit.
Q.
Okay.
You said the division of system utilization and review is
divided into three areas?
A.
Correct.
Q.
And one of them was third party?
A.
Correct.
Q.
What are the other two?
A.
The other -- the other one was the Bureau of Business
Intelligence.
Q.
What does the Bureau Business Intelligence do?
A.
They provide support for the entire agency in terms of data
analytics, providing help to audit and investigators to analyze and to review
claims, to prepare audit packages, to work with federal and other state
agencies when Medicaid data is necessary.
Q.
And what about the third unit of Division of System Mobilization
Review?
A.
It's payment controls and monitoring.
There is a guest audit
unit in there which seeks to recoup inappropriate Medicaid expenditures.
There’s a dental unit which performs dental audits and prepayment reviews,
and then there's a medical prepayment review unit as well.
Q.
Do you supervise, Mr. Ryan, any staff?
A.
I have three bureau directors that report to me directly.
Q.
And how many people are under your direct provision *00:14:45?
A.
Approximately fifty.
Q.
Fifty?
A.
Yes.
Q.
Okay.
As the Deputy Medicaid Inspector General, what are your
duties and responsibilities as the Deputy Medicaid Inspector General,
Division of System Mobilization Review?
A.
Well, to oversee the three bureaus to make sure that they -- they
understand their roles and their responsibilities, to ensure that they live
up to those responsibilities, to coordinate activities with the rest of the
Medicaid Inspector General as far as -- as well as the Department of Health
and other State agencies and Attorney General, State Controller.
It’s a
management type function, you know, like, I don't really do a whole lot of
detailed work.
It’s more overseeing what the -- what my staff does and
coordinating with the rest of the agency.
Q.
Have you ever been asked to give testimony on administrative
hearings while you're employed with DSS or DOH or OMIG?
A.
Yes.
Q.
Do you recall how many times you've testified?
A.
Approximately five.
Q.
And what was the subject matter of your testimony?
A.
Usually, it had to do with a Medicaid provider audit.
Q.
Okay.
A.
Exactly.
Q.
Let me ask you about your relationship with Dr. Heiner.
Such as this particular one that we have *00:15:58?
I
presume -- I presume you're acquainted to Dr. Heiner, is that correct?
A.
I am.
Q.
When did you first meet Dr. Heiner?
A.
Probably in a late '90s.
Q.
Did you ever work with Dr. Heiner on any matters while you were
at your jobs -A.
Yes.
Q.
-- DSS, DOH and OMIG?
A.
Yes.
Q.
Approximately, how many matters have you worked with Dr. Heiner?
A.
At least hundreds.
Q.
And if those hundreds of matters that you've worked on with Dr.
Heiner, how many involved statistical sampling extrapolation?
A.
Most, I don't know it all, but possibly be all, but most of them,
vast majority.
Q.
Obviously, you're familiar when you worked on UCP audit with Dr.
Heiner, is that correct?
A.
Yes, I provided information to Dr. Heiner so that he could review
it, yeah.
Q.
Okay.
So, let's -- just tell the court.
Tell us, what were the
summon substances of your conversations with Dr. Heiner with respect to just
this particular audit?
A.
When I was contacted initially, I was totally -- I believe it was
Tina that contacted me -Q.
Ms. Dolman?
A.
Tina Dolman.
Q.
Right.
A.
And she said that a hearing had been requested and she would need
some information.
So, I set about doing what I normally do in that
situation, and I gathered up any necessary documentation.
I would have
emailed Dr. Heiner all the information that he needed to review what we had
done in that case, so that he could provide a certification as to the
validity of our process and the data in particular for this audit.
Q.
Okay.
Besides what you just told us, did you have any specific
conversations that you can recall with Dr. Heiner with respect to this audit,
if you recall?
A.
Yeah, I believe that Ms. Dolman forwarded me some information
from the providers, either from the provider or the provider’s attorney
wished to have some disputes which I would have forwarded to Dr. Heiner.
Q.
Okay.
Now I'd like to show you, Mr. Ryan, your certification
dated February 24th 2017.
I believe that's seven?
A.L.J. MULVEY:
MR. GLICK:
Oh, I'm sorry, five.
THE WITNESS:
BY MR. GLICK:
Five.
Okay.
(Cont'g.)
Q.
Mr. Ryan, are you familiar with that document?
A.
I am.
Q.
Can you tell the court what it is?
A.
The document that I helped put together with assistance from
attorneys, which kind of outlines what I -- the steps that I take when I need
to review an audit sample.
Q.
Yeah.
A.
In this case in particular --
Q.
Well, we'll go that in detail soon, but is that your signature at
the -- on page three at the bottom?
A.
That is my signature.
Q.
Approximately, how many of these certifications have you signed
for OMIG over the years, if you recall?
A.
Well, over a hundred but I don't recall the exact number.
Q.
Okay.
There are approximate and there was about ten numbered
paragraphs in this certification, is that correct?
A.
It's correct.
Q.
Now, I believe you said that you worked on these certifications
with the attorneys, what paragraphs in this certification are particular to
this particular audit?
A.
Paragraphs nine and ten would be the only -- the only paragraphs
that would differ from other certifications.
Q.
So, would I be correct in saying this is more of a template that
you use?
A.
Exactly.
Q.
And why would you use the template?
A.
Because *00:19:46 felt it would be wise to prevent this -- to
present the same certification because I do the same things every time I look
at and review an audit sample.
Q.
Okay.
So besides paragraphs nine and ten, everything else in
this certification have been using prior certifications?
A.
Yeah, except for the *00:20:03 the specific heading information
regarding audit number and the provider name and provider ID.
Q.
Okay.
Mr. Ryan, can you tell us what's an audit package?
A.
It's a collection of data put together by my staff for the
auditor reviews.
Q.
When you say collection of data, what are you referring to?
A.
Primarily Medicaid claim information but also associate
information about recipients and -- and files that were created during the
audit sample, creation of the audit sample.
There's a number of files which
get created and we store all of them together in a unique folder by audit
number.
Q.
On a computer -- on a computer?
A.
On a computer, our servers, yes.
Q.
Who in OMIG decide, Mr. Ryan, what's contained in an audit
package?
A.
The audit package is created for the auditor, so the Division of
Medicaid Audit over the years has met with us continually to request certain
information be included in an audit package.
So early on, we had a standard
package that we created and it has morphed over the years, but it’s basically
been at the request of the Division -- Division of Medicaid Audit.
Q.
Okay.
So, do you recall specifically what was contained in the
audit package for this particular audit?
A.
I -- I have a good idea because it's basically the same for every
audit package.
Q.
And what was that?
A.
Primary piece of information would be a Microsoft Access
Database.
Q.
What is that?
A.
A database would be a collection of tables, and you know a table
would be a subset of data.
Q.
And how do you access that?
A.
We create these files.
We start by running code against our
Medicaid data warehouse to extract an audit universe, which becomes part of
the Microsoft Audit Database.
Q.
Can you tell us what a data warehouse is?
A.
Data warehouse is a repository of Medicaid-related information,
primarily claim data but there's an awful lot of ancillary data as well,
recipient, provider information, things like that.
Q.
How does OMIG gain access to that, to data warehouse?
A.
There's -- through certain technology, we are allowed access from
our desktops.
We have to, you know, be trained on the warehouse itself, on
the structure of it, how to write code against it.
We can use Graphical User
Interfaces.
There's -- there's -- and
We can use Structured Query Language.
we can use the -- you know, *00:22:49 reports which are part of the Medicaid
data warehouse.
Q.
Are you trained on how to use these systems that you're talking
to us about?
A.
I was.
Q.
Okay.
Could you tell us, Mr. Ryan, are you familiar with the
term universe of claims?
A.
Yes.
Q.
What does that mean?
A.
When an auditor is assigned a case, a provider to audit, they
would determine an audit period, a scope of audit and they would present
certain criteria to my staff which would allow us to create a universe of
claims, which would correspond to the audit that they wanted to perform.
Q.
Who, Mr. Ryan if you know, decided what the universe would
contain in this particular audit?
A.
I honestly do not know who the auditor was who requested it.
Q.
Okay.
What, if any, if you know, are the differences between
dates of payment and dates of service?
A.
A date of service is the actual date where a provider would
provide a service to a Medicaid recipient.
A data payment would be a New
York State eMedNY generated piece of data which corresponds to a particular
cycle number or a weekly cycle number.
So, it would indicate the time that
that a claim -- a claim was actually paid.
Q.
In reference, you mentioned something about the eMedNY, can you
tell us what that is?
A.
eMedNY stands for Electronic Medicaid for New York.
It’s a --
it's the payment system that New York State uses to process and pay Medicaid
claims.
Q.
Mr. Ryan, what date either data service or data payment does OMIG
use in your audits?
A.
When we look to assemble an audit universe, we would use the date
of original payment to identify claims which should be included in that
universe.
Q.
And what was used in this audit, dates of payment and dates of
service?
A.
Dates of payment.
Q.
Who determine that it would be dates of payment?
A.
The auditor would ask for that.
Q.
Do you know who the auditor was in this particular case?
A.
I do not know.
Q.
Okay.
A.
I don't know if determine is the right word.
Who determined the sampling frame for this audit?
criteria from the auditor, we create an audit universe.
Once we receive
Data audit universe
consists of many data elements and many records, all of which fall within the
audit period.
Q.
So *00:25:31 if I took out the word ‘determine’ and I put the
word ‘develop’.
Who developed the sampling frame for this audit, would that
be a better way?
A.
Yeah, my staff specifically to reach a goal.
Q.
And what -- what is a sampling frame?
A.
Sampling frame is a subset of data from which you would -- an
auditor or an analyst would select a sample, and upon reviewing that sample
and obtaining results would extrapolate the results back to that same
sampling frame.
Q.
Can you tell the court what CRN1 means?
A.
It's a -- a column heading.
It stands for claim reference
number.
Q.
And what’s the one?
A.
Just to distinguish it.
I mean, there's various claim reference
information, and the one really doesn't mean anything.
It just distinguishes
it from a CRN.
Q.
And what does OCRN mean?
A.
OCRN is Original Claim Reference Number, very similar to a claim
reference number, but it's unique throughout the claim.
In other words, a
claim can have an original payment and several subsequent adjustments, and we
need a piece of information to tile them together because the CRN1 as you
pointed out, it's different.
You can have a several claim reference numbers
for the same claim, but they would all have the same unique original claim
reference number, and that is how we -- we consolidate various records into
one unique claim or one unique record per claim.
Q.
And this particular audit or for this particular audit, how can
the sampling frame be replicated from the universe?
A.
You would run a query to consolidate the universe into unique
original claim reference numbers.
Q.
OCRN?
A.
OCRN.
Q.
Okay.
A.
And sum the amount paid and that would give you one record per
unique claim with a total dollar amount for that claim.
Q.
What if I use CRN?
Can I do the same thing?
A.
You would get different results.
Q.
Okay.
Who, Mr. Ryan, if you know, determine the size of the
sample in this particular audit?
A.
The audit staff requested -- would -- would have requested the
number of records that they wanted to sample.
Q.
Do you know, if you do know, what was the criteria for choosing
the size of the sample in this particular case?
A.
Well, the audit staff seeks to maximize that resources and do as
many audits as they can and keep the burden on the provider as low as
possible.
So, they like to do smaller samples, and we have determined that
one hundred is the smallest sample that we would allow them to do.
So,
basically a lot of their samples and this one in particular, have been
requested at one hundred records.
Q.
Okay.
Who determines or who determine what claims information
was to be contained in this particular audit?
A.
I'm not sure what you mean by what claim information.
Q.
Well, what information is in the audit package?
A.
The audit package would be standard and it would have been
developed between the Division of Medicaid Audit and my unit Bureau of
Business Intelligence in particular.
Again, it has morphed over the years,
but the data elements included are at the request of the audit staff.
Q.
Okay.
Would claims information contain the -- the amount of a
particular service?
A.
The amount paid to the provider, yes it would.
Q.
What else would it contain?
A.
Provider ID, provider name, recipient ID, recipient name, dates
of service, revenue code, rate codes, amount Medicaid paid, amount paid by a
commercial insurer, claims cycle number, pay date, date of service if I
didn't say that already.
And again, this is -- this is a -- a standard
structure which I could provide.
I just can't remember all the data elements
included.
Q.
All right.
Okay.
Could you tell us if you know what’s a seed?
A.
A seed as it relates to what we're talking about is a --
Q.
Yes.
A.
-- a starting point for a random sample.
Q.
Okay.
If you know, what at the time of this particular audit was
the OMIG's policy with respect to preserving or saving a seed?
A.
The application in our process did not retain the seed.
Q.
And who, if you know, determined that policy?
A.
That policy was developed by audit managers back probably in the
early thousands in concert with Dr. Heiner.
I can remember discussions.
really don't know who made the final decision to not retain.
Q.
Okay.
[End of Audio]
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