ST.THERESE MEDICAL CENTER, Claimant, 0. THE STATE OF ILLINOIS, Respondent.
Case summary
The hospital sought payment for nine patient accounts under the Medical Assistance Program. The court dismissed the claims because the hospital submitted invoices more than one year after services were rendered, violating the one-year deadline under IDPA Rule 140.20.
Statutes cited: Ill. Rev. Stat. 1991, ch. 37, par. 439.8(a); Ill. Rev. Stat. 1991, ch. 23, par. 11-13; Ill. Rev. Stat. 1991, ch. 110, par. 2-615(e); 89 Ill. Adm. Code 140.20; 42 C.F.R. 447.45(d)
Cases cited: Good Samaritan Hospital v. State (1982), 35 Ill. Ct. Cl. 379; Barnes Hospital v. State, No. 82 CC 708 (order filed Mar. 1, 1982); Rock Island Franciscan Hospital v. State, No. 82 CC 899 (order filed May 3, 1982); St. Joseph Hospital v. State, No. 82 CC 2440 (order filed Oct. 22, 1984); Methodist Medical Center v. State (1986), 38 Ill. Ct. Cl. 208; Rock Island Franciscan Hospital v. State (1987), 39 Ill. Ct. Cl. 100; Franciscan Medical Center v. State, No. 84 CC 118 (opinion filed Feb. 26, 1988); Pinckneyville Medical Group v. State (1988), 41 Ill. Ct. Cl. 176; Treister & Wilcox v. State (1989), 42 Ill. Ct. Cl. 185; Sarah Bush Lincoln Health Center v. State (1989), 42 Ill. Ct. Cl. 303
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Headnotes
- R OLAND W. BURRIS,Attorney General (CYNTHIA J. W OOD, Assistant Attorney General, of counsel), for Respondent,
- P UBLIC A ID CODE-Vendor-payWnt claims-invoice submittal requirements. Pursuant to the rules of the Illinois Department of Public Aid and corresponding Federal regulations, a medical provider’s vendor-payment claim, to be eligible for payment consideration either as an initial or resubmitted invoice following prior rejection, must be received by the Department no later than 12 months from the date on which medical goods or services are provided, and invoices which do not comply with this requirement are not eligible’forpayment under the Department’s Medical Assistance Program.
- V ENDOR-P AYMENT CLAIMS-hospital failed to comply with one-year invoice submittal deadline-claims dismissed. A hospital’s claims under section 11- 13 of the Public Aid Code seeking payment of charges relating to nine different patient accounts were dismissed since, in each case, the invoice supporting the vendor-payment claim was received by the Department of Public Aid more than one year following the date on which the services were rendered, and two of the claims had been previously barred in any event for failure to commence the actions within the time prescribed by statute.
OPINION
S OMMER, J. These nine Court actions were filed pursuant to the “law or regulation” provisions of section 439.8(a) of the Court of Claims Act (or “CCA) (Ill. Rev. Stat. 1991, ch. 37, par. 439.8(a)) and section 11-13 of the Public Aid Code ( or “PAC”) (Ill. Rev. Stat. 1991, ch. 23, par. 11-13). The common issue presented in these vendorpayment actions is whether Claimant hospital’s complaints have established a p r i m facie right to receive payment, under the Medical Assistance Program (MAP) administered by the Illinois Department of Public Aid (IDPA), of charges relating to any of nine patient accounts. Respondent has moved for judgment on the pleadings in each of these actions (pursuant to section 2-615(e) of the Code of Civil Procedure (Ill. Rev. Stat. 1991, ch. 110, par. 2-615(e))), contending that none of the complaints establishes a prima facie right to payment, because in none of these instances does Claimant show that it had complied with the one-year invoice submittal deadline imposed upon medical vendors by IDPA Rule 140.20 (89 Ill. Adm. Code $140.20, reprinted in Topic 141 of IDPA’s MAP Handbook For Hospitals) and by Federal Medicaid regulation (42 C.F.R. $447.45(d)).
Respondent also contends that Claimant’s causes of action as to two accounts ( N o s . 92 CC 3328 & 92 CC 3342) had previously been barred from prosecution in this Court at the time said claims were filed herein. For reasons explained in this opinion, the Court agrees with Respondent’s contentions.
The patient names and related dates of service com[*372]prising these eight outpatient (OP) and single inpatient (IP) accounts, the dates on which Claiimant submitted its related form UB-82 invoices (presenting its account charges) to IDPA, the dates on which the Department received those invoices, and the dates of IDPA’s refusalto-pay notices to Claimant, were as foll.ows:
Claimant’sUB-82 Invoice
Patient Account/ Submittal Date, as alleged/ Date of IDPKs
Date(s)of Date Invoice Received $11-13 Payment
Service (DOS) by IDPA Refusal Notice Castillo (OP), No. 92 CC 3324 submitted October 30,1991 DOS:August 21, 1990 received November 7,1991 Dec. 5,1991 Cofield (OP), No. 92 CC 3322 submitted March 4,1992 DOS: March 7, 1991 received March 11,1992 April 6,1992 Ford (IP), No. 92 CC 3328 submitted October 22,1!391 DOS: September 12-16,1990 received October 24,1991 Nov. 26,1991 Home (OP), No. 92 CC 3326 submitted January25,1992 DOS: January25,1991 ’ received February 5,1992 Feb. 14,1992 King (OF’), No. 92 CC 3323 submittedJanuary25,1992 DOS: January 12, 1991 received February 5,1992 Feb. 14,1992 Kirby (OP), No. 92 CC 3342 submitted April 25,1991 DOS: December 14, 1989 received April 29, 1991 May 28,1991 Kuykendall (OP), No. 92 CC 3325 submitted January22,1992 DOS: November 24.1990 received January29,1992 Feb. 11,1992 Quijada (OP), No. 92 CC 3327 submitted January30,1992 .
DOS: November 19,1990 received February 7,1992 Feb. 18,1992 Quijada (OP), No. 92 CC 3321 submittedJanuary30,1992 DOS: November 23,1990 received February 7,1992 Feb. 18, 1992 In each instance, Claimant alleges a single invoice in support of its Court claim. And in each case, that invoice (a) had been received by the Department more than one year following the date on which the services had been rendered; and (b) was refused payment with the rejection-notice .message advising Claimant that IDPA “will not consider for payment any UB 82 received for charges more than 12 months from the date of service.” (Handbook For Hospitals, App. H-15.)
Subsections (c) and (d) of IDPA Rule 140.20provide as follows: “(c) To be eligible for payment consideration, a [medical vendor’s] vendorpayment [administrative] claim or bill [i.e., invoice], either as an initial or resubmitted [invoice] following prior rejection, must be received by [IDPA], or its fiscal intermediary, no later than twelve (12) months from [*373] the date on which medical goods or services are provided. (d) [Invoices]which are not submitted and received in compliance with the foregoing requirements will not be eligible for payment under [IDPA’S MAP], and the State shall have no liability for payment thereof.” (89 Ill. Adm. Code $140.20, as amended at 13 Ill. Reg. 7799 through 7801, effective May 20, 1989; and see Topic 141.2 of IDPA’s MAP vendor Handhooks as amended on June 15,1989.)
The Federal regulation (42 C.F.R. $447.45) imposes a similar deadline, viz., IDPA as Illinois’ Medicaid agency “must require [medical vendors] to submit all [invoices] no later than 12 months from the date of service.” (Id., $447.45(d),originally published in 44 FR 30344 on May 25, 1979.) Respondent risks its entitlement to Federal Medicaid funding of IDPA’s MAP, if compliance with this one-year deadline is not routinely enforced. (See Peterson v. State (1990), 43 Ill. Ct. C1. 347; Forutan v. State (1991), 43 Ill. Ct. C1. 377; Kim o. State (1991), 43 Ill. Ct.
C1. 286, and Lawrie v. Illinois Department of Public Aid (1978), 72 Ill. 2d 335, 343-44.) Accordingly, this Court has consistently determined that a vendor-claimant’s claim does not merit an award, if the vendor has failed to submit a “clean claim” invoice (42 C.F.K. $447,45(b))-or, as here, any invoice-to IDPA, within one year following the date on which the charged services were rendered. (Good Samaritan Hospital o. State (1982), 35 Ill. Ct. C1. 379; Barnes Hospital o. State, No. 82 CC 708 (order filed Mar. 1, 1982); Rock Island Franciscan Hospital 0. State, No. 82 CC 899 (order filed May 3, 1982); St. Joseph Hospital v. State, No. 82 CC 2440 (order filed Oct. 22, 1984); Methodist Medical Center o.
State (1986), 38 Ill. Ct. CI. 208; Rock Zsland Franciscan Hospital o. State (1987), 39 Ill. Ct. C1. 100; Franciscan Medical Center o. State, No. 84 CC 118 (opinion filed Feb. 26, 1988); Pinckneyville Medical Group o. Siate (1988), 41 Ill. Ct. C1. 176; Treister G Wilcox o. State (1989), 42 Ill. Ct. CI. 185; Sarah Bush Lincoln Health [*374] Center v. State (1989), 42 111. Ct. C1. 303; Ryan v. State (1990),43 Ill. Ct. C1. 213; Ramubrahmam v. State (1990), 43 Ill. Ct. C1. 351; Peterson, Forutan 8r Kim, cited supra; St. Francis Hospital v. State (1992), 44 Ill. Ct. C1. 157; and Christ Hospital v. State, No. 92 CC 18 (opinion filed March 24, 1992).)Applying the provisions of IDPA Rule 140.20(d) to the facts here pleaded in support of these nine accounts, the Court concludes th<atno State liability exists for paying these accounts.
IDPA records show that Claimant had initially submitted a timely invoice, for patient Ford’s September 12- 16, 1990 inpatient stay (UB-82 submitted Oct. 19, 1990, received on Oct. 26, 1990), which was not here alleged in Claimant’s complaint