Memorial Medical Center v. State of Illinois

Respondent has moved for summary judgment on this vendor-payment claim, filed under the provisions of section 11-13 of the Public Aid Code (Ill. Rev. Stat. 1985, ch. 23, par. 11-13), on the ground that the documents submitted by Claimant, in support of its claim, fail to establish its compliance with applicable statutory law and related requirements. The Claimant having received due notice, the Court finds as follows:

Claimant hospital is seeking a vendor payment under the Medical Assistance Program (MAP) administered by the Illinois Department of Public Aid (IDPA). The questions presented for resolution are whether Claimant’s services here related to an abortion per[*75]formed on its Medicaid-recipient patient, whether Claimant fully and accurately identified its medical services in invoicing them for IDPA’s payment consideration, and whether Claimant had demonstrated its compliance with IDPA’s requirements, as conditions precedent to its entitlement to payment for these services.

IDPA’s report, the contents of which are prima facie evidence under Court Rule 14, advises that Claimant submitted a single invoice, without any attached document, for these March 1982 services. IDPA notes that the information supplied by Claimant is inconsistent, in that its entries on the IDPA invoice-form are contradictory in describing the services which Claimant rendered to its patient. Although one coded entry on the invoice represents that no surgery was performed during the patient’s inpatient stay, Claimant’s ancillary-service entries include charges for operating room, recovery room and anesthesiology; and its “accommodation” entries describe this as a surgical stay. As disclosed in its invoice, Claimant’s services included surgical services, and contrary to IDPA’s invoice-preparation requirements, Claimant failed to identify the surgical procedure which was performed on the patient. Compare IDPA’s requirements for invoice-reporting of services rendered, as discussed in Methodist Medical Center v . State (1986), 38 Ill. Ct. C1. 208,209-10.

One of Claimant’s invoice-entries identifies that surgery as an abortion, performed on Claimant’s patient during the stay being invoiced. The invoiced charges were disallowed for payment by IDPA, on a voucher dated April 2, 1982. The voucher notifiedmclaimant that the disallowance resulted from Claimant’s failure to submit an abortion certification form with its invoice.

[*76] The significance of Claimant’s abortion-code entry is found in certain prohibitions, in State and Federal law, against IDPA’s payment for abortion-related services. Section 5-5 of the PAC excludes such services from those types of medical treatment for which IDPA was authorized to pay. As of March 1982, when Claimant rendered the services here at issue, the General Assembly had directed that payment was to be authorized for: 0 0

any other medical care, O

, but not including abortions, or induced miscarriages or premature births, unless, in the opinion of a physician, such procedures are necessary for the preservation of the life of the woman seeking such treatment, or except an induced premature birth intended to produce a live viable child and such procedure is necessary for the health of the mother or her unborn child. (Ill. Rev. Stat. 1985, ch. 23, par. 5-5.) In assessing the payment-entitlement of an invoice submitted under any exception to the above prohibition, IDPA is to require:

0 0 0

that a written statement including the required opinion of a physician

shall accompany any claim for reimbursement for abortions, induced .miscarriages or premature births. This statement shall indicate what

procedures were used in providing such medical services. (Ibid.) Respondent has no authority to make payment unless the vendor’s invoice for abortion-related services is documented in accordance with the requirements of section 5-5.

The U.S. Congress enacted legislation which has a similar prohibitive effect upon Respondent’s payment for abortions for Medicaid recipients. The so-called Hyde amendments deny Federal Medicaid matching funds (“Federal financial participation,” or FFP) for the States’ costs of paying medical vendors for performing abortions, except under specified circumstances. See generally Harris v. McRae (1980), 448 U.S. 297, 100 S. Ct. 2671, 65 L. Ed. 2d 784; and see William v . Zbaraz (1980), 448 U.S. 358, 100 S. Ct. 2694, 65 L. Ed. 2d 831, [*77] involving a constitutional challenge of section 5-5 of Illinois’ PAC. The Hyde amendment exceptions would require a physician’s written certification as to the patient’s medical condition, similar in content to that required under section 5-5.

The Federal physician-certification requirements appear in sections 441.203 and 441.206, of title 42, Code of Federal Regulations; and are further explained in IDPA Rule 140.413 (89 Ill. Admin. Code 4140.413). A hospital can comply with these State and Federal requirements by insuring that its invoice, submitted to IDPA, is accompanied by an abortion payment application (DPA form 2390), a form in which the physician certifies in his or her professional judgment that the named recipient’s life would be endangered if her fetus were carried to term.

As noted, Claimant hospital’s invoice listed inconsistent entries, and was deficient in its failure to identify the surgical procedure performed. No explanatory documents accompanied it. If these services ,were related to abortion surgery, then Claimant could have submitted a correctly prepared, “rebill” invoice, entering the code for the specific abortion procedure which was performed on the patient, and attaching a certification form (DPA 2390) completed by her physician, describing the emergent circumstances which . occasioned that particular procedure. If no abortion had been performed-and the initial invoice was incorrect in that respect, then Claimant’s rebill-invoice could have corrected the erroneous entries and accurately identified the procedure which was in fact performed. In this case, however, Claimant failed to submit any rebill-invoice. IDPA reports receiving no rebill of these services, containing internally consistent entries and identifying the procedure which was performed. Claimant does not [*78] allege that any such rebill was submitted, within the oneyear period following the patient’s stay, as required by subsection (d) of IDPA Rule 140.20, and by 42 CFR 4447.45. Good Samaritan Hospital v . State (1982),35 Ill. Ct. C1. 379; Rock Zsland Franciscan Hospital v. State, 39 Ill. Ct. C1. 100; and Riverside Medical Center v. State (1986), 39 Ill. Ct. C1. 301.

Respondent has attempted, through discovery, to seek Claimant’s production of its records, including any abortion certification or other documents identifying the surgical procedure and showing whether Claimant had complied with applicable IDPA rule requirements. Claimant answered by admitting each allegation in Respondent’s request for admission of facts, thereby representing that Claimant has no relevant documents to produce, other than those submitted with its complaint.

The Court finds that it can make no vendorpayment award in this matter. If IDPA is to administer its program in accordance with applicable requirements, then vendors must be expected to identify the medical services for which they are charging, by completing and documenting IDPA’s invoice-f orms in accordance with those requirements. It is apparent that Claimant failed to do so in this instance. As a result, neither Respondent nor the Court is able’ to determine, from this record, what specific services Claimant has rendered and is seeking payment for.

IDPA is obligated to require that vendors report their services accurately and consistently, as a condition precedent to being paid for them; and the State risks a denial of Federal financial participation (FFP) in its MAP expenditures if IDPA fails to do so. [W]e note that the federal government’s continuing participation in the funding of Illinois’ MAP program is dependent upon IDPA’s regular [*79] enforcement of these regulatory requirements. Applicable here are the requirements: that medical vendors must fully and correctly complete their invoice-forms being submitted for IDPA’s payment consideration, so as properly to identify the services being invoiced ’ ’ ’ and that correctlyprepared invoices be timely received by IDPA. (Methodist Medical Center u. State (1986), 38 Ill. Ct. CI. 208,210.)

We find no occasion here to depart from our prior holdings and thereby risk jeopardizing Respondent’s continuing entitlement to Federal matching funds for IDPA Medical Assistance Program expenditures.

Respondent also asserts that Claimant’s cause of action for payment of these services had already been barred, under section 11-13 of the Public Aid Code (Ill. Rev. Stat. 1983, ch. 23, par. 11-13), when this Court action was filed. IDPA’s position is that the limitations bar of the Court of Claims Act deprives Claimant of the opportunity to seek payment for these services before this Court. Ill. Rev. Stat. 1985, ch. 37, par. 439.22.

Under section 11-13, a vendor’s cause of action “accrued” upon IDPA’s written notification that it was disallowing a vendor’s “claim” (invoice). Here, Claimant’s claim was disallowed on April 2, 1982. The statute provided that vendors “shall commence their actions & * + a

within one year next after’’ such accrual. In this instance, Claimant commenced its action, seeking to enforce payment of this patient account, on May 2,1983, more than one year following accrual of its cause in respect to that account. We agree that this action was not timely filed, and thus that Claimant’s cause as to this account had already been “forever barred from prosecution” under section 22 of the Court of Claims Act. Ill. Rev. Stat. 1985, ch. 37, par. 439.22.

It is therefore ordered that Respondent’s motion for summary judgment on the complaint and underlying cause, based upon the grounds addressed above in this opinion, is hereby granted; judgment is entered against [*80] the Claimant and in favor of the Respondent; and the claim is dismissed with prejudice.

(No. 83-CC-%%-Claim denied.)

THOMAS J. SNEED and BARBARA A. SNEED, Claimants, 0.

THE STATE OF ILLINOIS, Respondent.

Order on motion to dismiss filed August 18,1983.

Order on rehearing filed September 7,1984.

Opinion filed March 15,1988.

Order on denial of rehearing filed May 13,1988.

T HOMAS J. 'SNEED and BARBARA A. SNEED, pro se, for Claimants.

NEIL F. H ARTIGAN , Attorney General (C LAIRE GIBSON TAYLOR, Assistant Attorney General, of counsel), for Respondent.

HrcHwAYs-natural drainage-rights of servient owner. The owner of land which is servient to and provides natural drainage for the surface waters of higher lands may obtain an easement by prescription to free his land of the natural burden, and as to the surface water drainage, the owner of the servient land may, under certain circumstances reverse the natural benefit of the dominant land by constructing a levee or other barrier to the natural drainage.

SAME-highway construction-flooding damage-burden of proof not met-claim denied. Claimants suffered a crop loss and resulting damages to their truck-farm operation due to flooding allegedly caused by the disruption of the drainage near their property during the construction of a highway, but their claim for the loss was denied in view of the Claimants' failure to establish that the barrier the State allegedly failed to replace ever existed.

ORDER ON MOTION TO DISMISS

ROE, J.

This cause having come for consideration on the [*81] Respondent’s motion to dismiss and the Court being duly advised in the premises:

Finds, that the claim No. 83-CC-2496 is a duplicate of claim No. 81-CC-2195.

It is hereby ordered, that this cause be dismissed with prejudice.

ORDER O N REHEARING

ROE, J.

This cause comes on to be heard on the Claimant’s petition for rehearing, it appearing that due notice has been given, and the .Court being fully advised in the premises;

It is hereby ordered that our order of August 18, 1983, be, and hereby is, vacated and Respondent’s motion to dismiss is hereby denied.

OPINION

POCH,J.

This claim‘is for crop loss due to flooding in the spring of 1983. Hearings were conducted before Commissioner Robert H. Rath. Both parties have filed their briefs and Commissioner Rath has duly filed his report.

This claim is a sequel to the claim of Claimants adjudicated in cause No. 81-CC-2195 before this Court in which Claimants were awarded damages. In this case, Claimants seek an award based on damages to their truck-farm operation in the flood of 1983 and involve similar, though not identical, issues as previously adjudicated.

Claimants contend that during the construction oE [*82] ‘Interstate 57 through Alexander County by the State of Illinois, Respondent removed dirt from a public roadway known as the Sears-Roebuck Road thereby permitting the drainage of water to flow upon and across the above-mentioned public roadway flooding their property and damaging fruit trees, wheat, a strawberry patch, onions and cabbage.

Claimants’ main contention is that the State has failed to replace the Sears-Roebuck Road in the manner and condition that this road existed prior to the construction of Interstate 57, including the condition of culverts and water control flaps installed on culverts.

At the hearing in this case, Claimants testified that subsequent to the prior case the State attempted to replace the contour of the Sears-Roebuck Road but failed to “finish the job.” Further, Claimants contend that the State failed to replace a water control “flap” on a culvert to impede the flow of water so that water would only run north to the point of the flap and not beyond so as to flood Claimants’ property.

Claimants’ theory necessarily asserts that the State is responsible for restoring the contours and impediments to the flow of water that existed prior to the State’s construction of Interstate 57. Critical to the case of the Claimants is proof of the condition of the Sears-Roebuck Road prior to the construction of Interstate 57 including such culverts and water control flaps as may have existed at that time. In the previous case, Claimants succeeded in showing that a portion of the SearsRoebuck Road had been removed which allowed water to flood Claimants’ land. It is now agreed by Claimants and Respondent that Respondent has restored the SearsRoebuck Road to its original condition in compliance with Claimants’ complaint in the earlier case.

[*83] Respondent’s agents testified that there is no record of culverts and water control flaps extant on the SearsRoebuck Road prior to the construction of Interstate 57 comparable to those described by the Claimants. Topographic survey books predating the construction of Interstate 57 in 1965 and 1969 portray certain pipes and water control devices crossing under the Sears-Roebuck Road but show no water control flaps. Richard Brake, a district field engineer of Respondent, testified that such flaps would have been shown if they had existed. Although a 10-inch metal pipe was restored under the Sears-Roebuck Road, no water flow flap gate was installed because no records could be found to support the contention that such a flap ever existed.

Mr. Sneed testified at length concerning his theory of the directional flow of flood waters to and from his property, yet, he failed to demonstrate that Respondent has continued in its negligence which resulted in Claimants’ first award in the preceding case. Claimants’ theories of liability are insufficiently supported to justify the conclusion that Claimants have met their burden of proof with respect to liability in this case.

Numerous photographs, maps, diagrams and topographic studies admitted in evidence and discussed on the record failed to show or convince, by a preponderance of the evidence, that the State has failed to replace such impediments as may have existed prior to the construction of Interstate 57 or that it has contributed in any other way to Claimants’ water control problem.

There is no question that an owner of land which, by reason of its elevation, is servient to, and provides natural drainage for, the surface waters of higher lands may, by prescription, obtain an easement to free his land [*84] of the natural burden. As to surface water drainage, the owner of servient land may, by the construction of a levee or other barrier to natural drainage, reverse the natural benefit of dominant land and insist that water not be permitted to fall onto the owner’s servient estate. (Montgomery v . Downey (1959), 17 Ill. 2d 451, 162 N.E.2d 6.) Critical to this proposition, however, is a showing of the condition or existence of the levee or other barrier to natural drainage which has existed by prescription and entitles the owner of the servient land to maintain the barrier. Claimants have failed to establish the condition or existence of the barrier with evidence sufficient to meet their burden of proof in this claim for damages against Respondent.

For the reasons stated above, it is the decision of the Court that this claim be, and hereby is, denied.

ORDER ON DENIAL OF REHEARING

POCH,J.

This court having considered the Claimants’ request for rehearing as well, as the Respondent’s reply and objection thereto, and being fully advised in the premises, finds that the Claimants have failed to set forth matters not previously considered by this Court pursuant to Supreme Court Rule 367 at 87 Ill. 2d R. 367. It is therefore ordered that Claimants’ request for rehearing is denied.