{
  "id": 3114044,
  "name": "Memorial Medical Center, Claimant, v. The State of Illinois, Respondent",
  "name_abbreviation": "Memorial Medical Center v. State",
  "decision_date": "1988-02-04",
  "docket_number": "No. 83-CC-2254",
  "first_page": "73",
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    "id": 8793,
    "name": "Illinois Court of Claims"
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    "name": "Ill."
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      "category": "laws:admin_compilation",
      "reporter": "C.F.R.",
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      "year": 1980,
      "opinion_index": 0,
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    {
      "cite": "38 Ill. Ct. Cl. 208",
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      "reporter": "Ill. Ct. Cl.",
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  "last_updated": "2023-07-14T20:58:26.190856+00:00",
  "provenance": {
    "date_added": "2019-08-29",
    "source": "Harvard",
    "batch": "2018"
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  "casebody": {
    "judges": [],
    "parties": [
      "Memorial Medical Center, Claimant, v. The State of Illinois, Respondent."
    ],
    "opinions": [
      {
        "text": "POCH, J.\nRespondent has moved for summary judgment on this vendor-payment claim, filed under the provisions of section 11 \u2014 13 of the Public Aid Code (Ill. Rev. Stat. 1985, ch. 23, par. 11 \u2014 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:\nClaimant 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\u2019s services here related to an abortion performed on its Medicaid-recipient patient, whether Claimant fully and accurately identified its medical services in invoicing them for IDPA\u2019s payment consideration, and whether Claimant had demonstrated its compliance with IDPA\u2019s requirements, as conditions precedent to its entitlement to payment for these services.\nIDPA\u2019s 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\u2019s inpatient stay, Claimant\u2019s ancillary-service entries include charges for operating room, recovery room and anesthesiology; and its \u201caccommodation\u201d entries describe this as a surgical stay. As disclosed in its invoice, Claimant\u2019s services included surgical services, and contrary to IDPA\u2019s invoice-preparation requirements, Claimant failed to identify the surgical procedure which was performed on the patient. Compare IDPA\u2019s requirements for invoice-reporting of services rendered, as discussed in Methodist Medical Center v. State (1986), 38 Ill. Ct. Cl. 208, 209-10.\nOne of Claimant\u2019s invoice-entries identifies that surgery as an abortion, performed on Claimant\u2019s patient during the stay being invoiced. The invoiced charges were disallowed for payment by IDPA, on a voucher dated April 2,1982. The voucher notified Claimant that the disallowance resulted from Claimant\u2019s failure to submit an abortion certification form with its invoice.\nThe significance of Claimant\u2019s abortion-code entry is found in certain prohibitions, in State and Federal law, against IDPA\u2019s payment for abortion-related services. Section 5 \u2014 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:\n\u00b0 \u00b0 \u00b0 any other medical care, \u00b0 \u00b0 \u201c, 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 \u2014 5.)\nIn assessing the payment-entitlement of an invoice submitted under any exception to the above prohibition, IDPA is to require:\n\u00b0 \u00b0 \u00b0 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.)\nRespondent has no authority to make payment unless the vendor\u2019s invoice for abortion-related services is documented in accordance with the requirements of section 5 \u2014 5.\nThe U.S. Congress enacted legislation which has a similar prohibitive effect upon Respondent\u2019s payment for abortions for Medicaid recipients. The so-called Hyde amendments deny Federal Medicaid matching funds (\u201cFederal financial participation,\u201d or FFP) for the States\u2019 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, involving a constitutional challenge of section 5 \u2014 5 of Illinois\u2019 PAC. The Hyde amendment exceptions would require a physician\u2019s written certification as to the patient\u2019s medical condition, similar in content to that required under section 5 \u2014 5.\nThe 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 \u00a7140.413). 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\u2019s life would be endangered if her fetus were carried to term.\nAs noted, Claimant hospital\u2019s 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, \u201crebill\u201d 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 \u2014 and the initial invoice was incorrect in that respect, then Claimant\u2019s 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 allege that any such rebill was submitted, within the one-year period following the patient\u2019s stay, as required by subsection (d) of IDPA Rule 140.20, and by 42 CFR \u00a7447.45. Good Samaritan Hospital v. State (1982), 35 Ill. Ct. Cl. 379; Rock Island Franciscan Hospital v. State, 39 Ill. Ct. Cl. 100; and Riverside Medical Center v. State (1986), 39 Ill. Ct. Cl. 301.\nRespondent has attempted, through discovery, to seek Claimant\u2019s 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\u2019s request for admission of facts, thereby representing that Claimant has no relevant documents to produce, other than those submitted with its complaint.\nThe Court finds that it can make no vendor-payment 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\u2019s invoice-forms 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.\nIDPA 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.\n[W]e note that the federal government\u2019s continuing participation in the funding of Illinois\u2019 MAP program is dependent upon IDPA\u2019s regular 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\u2019s payment consideration, so as properly to identify the services being invoiced; 0 \u00b0 \u00b0 and that correctly-prepared invoices be timely received by IDPA. (Methodist Medical Center v. State (1986), 38 Ill. Ct. Cl. 208, 210.)\nWe find no occasion here to depart from our prior holdings and thereby risk jeopardizing Respondent\u2019s continuing entitlement to Federal matching funds for IDPA Medical Assistance Program expenditures.\nRespondent also asserts that Claimant\u2019s cause of action for payment of these services had already been barred, under section 11 \u2014 13 of the Public Aid Code (Ill. Rev. Stat. 1983, ch. 23, par. 11 \u2014 13), when this Court action was filed. IDPA\u2019s 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.\nUnder section 11 \u2014 13, a vendor\u2019s cause of action \u201caccrued\u201d upon IDPA\u2019s written notification that it was disallowing a vendor\u2019s \u201cclaim\u201d (invoice). Here, Claimant\u2019s claim was disallowed on April 2, 1982. The statute provided that vendors \u201cshall commence their actions * * * within one year next after\u201d 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\u2019s cause as to this account had already been \u201cforever barred from prosecution\u201d under section 22 of the Court of Claims Act. Ill. Rev. Stat. 1985, ch. 37, par. 439.22.\nIt is therefore ordered that Respondent\u2019s 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 the Claimant and in favor of the Respondent; and the claim is dismissed with prejudice.",
        "type": "majority",
        "author": "POCH, J."
      }
    ],
    "attorneys": [
      "Donald M. Craven, for Claimant.",
      "Neil F. Hartigan, Attorney General (Claire Gibson Taylor, Assistant Attorney General, of counsel), for Respondent."
    ],
    "corrections": "",
    "head_matter": "(No. 83-CC-2254\nMemorial Medical Center, Claimant, v. The State of Illinois, Respondent.\nOpinion filed February 4, 1988.\nDonald M. Craven, for Claimant.\nNeil F. Hartigan, Attorney General (Claire Gibson Taylor, Assistant Attorney General, of counsel), for Respondent."
  },
  "file_name": "0073-01",
  "first_page_order": 175,
  "last_page_order": 182
}