{
  "id": 3175410,
  "name": "Raj Gupta, M.D., Claimant, v. The State of Illinois, Respondent",
  "name_abbreviation": "Gupta v. State",
  "decision_date": "1990-05-24",
  "docket_number": "No. 88-CC-4548",
  "first_page": "269",
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      "cite": "39 Ill. Ct. Cl. 150",
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  "last_updated": "2023-07-14T21:02:18.861628+00:00",
  "provenance": {
    "date_added": "2019-08-29",
    "source": "Harvard",
    "batch": "2018"
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  "casebody": {
    "judges": [],
    "parties": [
      "Raj Gupta, M.D., Claimant, v. The State of Illinois, Respondent."
    ],
    "opinions": [
      {
        "text": "Sommer, J.\nDr. Gupta, a physician, filed this action on June 22, 1988, as a lapsed-appropriation claim in which he names the Illinois Department of Children and Family Services (DCFS) as responding agency. He is seeking payment for medical services which he had rendered during the period December 1 through 8,1986, to a child who was then a foster-care ward of DCFS. Respondent has moved to dismiss the claim pursuant to Section 790.90 of the Court of Claims Rules (74 111. Adm. Code 790.90), subsections (1) and (5) of section 2 \u2014 619 of the Code of Civil Procedure (111. Rev. Stat., ch. 110, par. 2 \u2014 619(1), (5)), section 22(b) of the Court of Claims Act (111. Rev. Stat., ch. 37, par. 439.22(b)), and section 11 \u2014 13 of the Public Aid Code (111. Rev. Stat., ch. 23, par. 11 \u2014 13). Respondent contends that, as Claimant Gupta\u2019s patient was a recipient under the Medical Assistance Program (MAP) administered by the Illinois Department of Public Aid (IDPA) when these services were rendered, and as IDPA has sole vendor payment responsibility for recipients\u2019 medical care, the validity of this claim must be assessed against vendor-payment requirements, e.g., those recognized in Canlas v. State (1987), 39 Ill. Ct. Cl. 150, and Krakora v. State (1987), 40 Ill. Ct. Cl. 233. Respondent cites, in this instance, Claimant\u2019s failure to commence this action within the limitation period prescribed by the above-referenced statutes.\nClaimant having received due notice of Respondent\u2019s motion, the Court makes the following findings.\nIn its report herein, IDPA describes the unique situation of foster-care children within the overall class of those individuals who receive Aid To Families With Dependent Children (AFDC) assistance. The basic needs of children in foster care (AFDC-F) and certain special needs of children receiving adoption assistance are provided by DCFS, in accordance with applicable State law and with Title IV-E of the Federal Social Security Act (sections 670 et seq., of Title 42, U.S.C.). The medical needs of AFDC-F and adoption-assistance children are, however, paid for by IDPA under its Medical Assistance Program (MAP), in the same manner that such care is provided, under Article V of the Public Aid Code, to other AFDC children. See sections 118, 222, and 308, part 435, 42 C.F.R.; and see IDPA Rules 112.306, 120.324 (89 111. Adm. Code 112.306, 120.324), and DCFS Rules 302.360, 359.9 (89 111. Adm. Code 302.360, 359.9).\nIn this case, Claimant\u2019s AFDC-F patient had been \u201cremoved from the home of the parent * * *, placed under the guardianship of [DCFS] * # and under such guardianship, placed in a foster family home\u201d (section 4 \u2014 1.2 of the Public Aid Code), and had thereby become qualified for AFDC recipient status under IDPA\u2019s MAP, prior to Claimant\u2019s rendition of the subject services. Throughout the child\u2019s foster-care placement (May 1985 through November 1987), IDPA had issued its medical eligibility cards to her foster parent, thereby enabling that parent to identify the child\u2019s AFDC-F (or \u201ccategory 98\u201d) eligibility status to vendors such as Claimant, from whom medical care for the child might be required. See Topics 130 and 131 of the MAP Handbook For Physicians and other MAP handbooks which IDPA issues to all MAP-participating vendors. In that IDPA, not DCFS, administers the Medical Assistance Program to which Claimant was obliged to invoice his charges for the subject services, and only IDPA possessed the funds appropriated for payment of Claimant\u2019s services, the statutory authority and payment mechanism to effect such payment, Claimant should appropriately have named IDPA as responding agency in this matter.\nIDPA reports that the hospital in which this AFDC-F child was a patient had timely invoiced its charges for care during this inpatient stay (Nov. 21 through Dec. 9, 1986), and had been paid by the Department on January 8, 1987. Invoices were also timely received from four other physicians involved in the child\u2019s treatment during this stay, and all MAP-covered services charged in those invoices had also been paid by IDPA, during the period January 8 through March 4, 1987. Each of said medical vendors\u2019 invoices had accurately identified the child whom they had treated, by listing the recipient identification number, or \u201cRIN,\u201d which IDPA had assigned to the child.\nRespondent also contends that Claimant\u2019s cause of action had already been barred by the time limitation imposed by section 22(b) of the Court of Claims Act and section 11 \u2014 13 of the Public Aid Code. We agree. The record in this case shows that Dr. Gupta invoiced his charges for the subject services to IDPA on December 23, 1986; that his DPA-form 2360 invoice listed an incorrect recipient identification number, or \u201cRIN.\u201d By voucher-response dated January 16,1987, IDPA notified Claimant that it was refusing to pay the invoiced service charges, because the \u201cRecipient (as misidentified by the incorrect RIN listed on the invoice), was Not Eligible on Date(s) Of Service.\u201d A vendor\u2019s invoice to IDPA, charging for services to a named patient, must correctly list the RIN which has been assigned to that patient. See Rock Island Franciscan Hospital v. State (1987), 39 Ill. Ct. Cl. 100; Simon v. State (1987), 40 Ill. Ct. Cl. 246, 249; Mercy Hospital and Medical Center v. State (1988), 40 Ill. Ct. Cl. 269, and prior decisions therein cited; Franciscan Medical Center v. State (1988), 84 CC 118; and Riverside Medical Center v. State (1988), 40 Ill. Ct. Cl. 274, 275.\nClaimant does not allege that he rebilled these services, with a corrected RIN, to IDPA, within the one-year period prescribed by IDPA Rule 140.20 (89 111. Adm. Code 140.20). Instead, he filed this Court action on June 22, 1988, more than one year following IDPA\u2019s notice of payment refusal. By that time, his cause of action in respect to these services had already been barred, as provided by the above-referenced statutes.\nIt is therefore hereby ordered that Respondent\u2019s motion to dismiss Dr. Gupta\u2019s complaint and underlying cause, on the grounds addressed above in this opinion, is hereby granted; and this claim is dismissed.",
        "type": "majority",
        "author": "Sommer, J."
      }
    ],
    "attorneys": [
      "Raj Gupta, M.D., pro se, for Claimant.",
      "Neil F. Hartigan, Attorney General (Steven Schmall, Assistant Attorney General, of counsel), for Respondent."
    ],
    "corrections": "",
    "head_matter": "(No. 88-CC-4548\nRaj Gupta, M.D., Claimant, v. The State of Illinois, Respondent.\nOpinion filed May 24, 1990.\nRaj Gupta, M.D., pro se, for Claimant.\nNeil F. Hartigan, Attorney General (Steven Schmall, Assistant Attorney General, of counsel), for Respondent."
  },
  "file_name": "0269-01",
  "first_page_order": 359,
  "last_page_order": 363
}