CHANG S. KIM, M.D., DOMINICK S. RENGA, M.D., and MICHAEL R. TREISTER, M.D., for TREISTER ORTHOPAEDIC SERVICES, LTD., Claimants, v. THE STATE OF ILLINOIS, Respondent.
Case summary
The claimants, physicians, sought payment for vendor services under the Public Aid Code. The court dismissed the claims, finding that many were barred by statutory time limits and that the court lacked jurisdiction over those accounts.
Statutes cited: Ill. Rev. Stat. 1987, ch. 110, par. 2-1005; 74 Ill. Admin. Code 9790.90; Ill. Rev. Stat. 1987, ch. 37, par. 439.22(b); Ill. Rev. Stat. 1987, ch. 23, par. 11-13
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Headnotes
- ROLAND W. BURRIS,Attorney General (STEVEN SCHMALL, Assistant Attorney General, of counsel), for Respondent.
- LIMITATIONS-When court of Chims k barred from considering merits of vendor-payment cbims. The Court of Claims lacks jurisdiction to consider the merits of those vendor-payment claims which were not commenced within the time periods prescribed by section 439.22(b)of the Court of Claims Act and section 11-13 of the Public Aid Code.
- V ENDOR-P AYMENT CLAirn-Court had no authority to award Chimants relief on vendor-payment actions-services rendered welfare recipients. In numerous vendor-payment actions based on claims for services rendered to welfare recipients, the Court of Claims had no authority to award Claimant physicians relief, since each of the causes as to the claims had been barred by statute prior to Claimants’ filing of the related actions.
- SAME-state not liable to pay physician Claimant for related procedures-failure to show clean claim rebill. In numerous vendorpayment actions based on claims for services rendered to welfare recipients, the State did not have to pay one physician Claimant for two related procedures, since Claimant failed to show that a clean claim rebill was received by the IDPA prior to regulatory deadline.
- PUBLIC AID CODE-physician’s claim for applying cast to welfare recipient denied. Physician Claimant’s charge for applying a cast to a welfare recipient was covered by the entire surgical-service package, which Illinois Department of Public Aid had previously paid under a separate invoice, and thus the State was not liable for thhis claim.
- MEDICAL SERvrcEs-physicians should have billed prepaid health care plans for services rather than Illinois Department of Public Aid. In numerous vendor-payment claims by physicians for services rendered to welfare recipients, several claims should have been billed to the prepaid health care plans, which coverage Illinois Department of Public Aid had purchased and was in force when Claimant’s services were rendered, instead of being billed to the Department.
- SAME-authorization of welfare recipient’s designated primary care physician required. In numerous vendor-payment claims by physicians for services rendered to welfare recipients, the State was not liable for one claim due to the physician’s failure to submit the written authorization of the recipient’s designated primary care physician, since such authorization is essential to the Department of Public Aids efforts to prevent overutilization of services.
- WELFARE-phySiCMn’S chims denied-tardy submission of invoices. In numerous vendor-payment claims by physicians for services rendered to welfare recipients, two physicians’claims were denied because they failed to establish that their charges had been invoiced to the IDPA in the manner and within the time prescribed by State and Federal regulatory requirements.
- OPINION AND JUDGMENT
The 251 captioned, vendor-payment actions are before the Court on Respondent’s motions for summary judgment as to each of them, pursuant to section 2-1005 of the Code of Civil Procedure (Ill. Rev. Stat. 1987, ch. 110, par. 2-1005), and for dismissal of 235 of said actions pursuant to section 2-619, Id., section 790.90 of the Court of Claims Regulations (74 Ill. Admin. Code 9790.90), section 22(b) of the Court of Claims Act (or [*288] “CCA,” Ill. Rev. Stat. 1987, ch. 37, par. 439.22(b)),and section 11-13 of the Public Aid Code (or “PAC,” ch. 23, Id.). The Claimant physicians having received notice of said motions, the Court finds as follows: Statutory Time Bur. Respondent asserts that Claimants’ causes of action, in 235 of these actions (each presenting charges for a single patient account) and additional, partial accounts in instances involving multiple dates of service, had previously been barred from prosecution as of March 4, 1988, the date on which they were filed with this Court. The State contends that the Court lacks jurisdiction to grant any relief as to such accounts. The actions and related accounts which Respondent challenges on this ground include: those seeking payment for services rendered on and before September 3, 1986, i.e., services rendered more than eighteen months prior to Claimants’ commencement of these actions (see PAC par. 11-13, subpar. (2));as well as those actions and accounts Claimants’ initial DPAform 2360 invoices for which IDPA had “refus[ed] to pay * * * in whole or in part” (Zd., subpar. (1)) in notices (IDPA voucher-responses or remittance advices) issued more than one year prior to March 4, 1988. The related services span the period from March 1982 (in No. 88- CC-2789) through November and December 1986 (Nos.