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10/13/88 the Department of Public v. Okin

October 13, 1988

THE DEPARTMENT OF PUBLIC AID EX REL. NEIL F. HARTIGAN, ATTORNEY GENERAL, PLAINTIFF-APPELLANT

v.

IRVING HOKIN, DEFENDANT-APPELLEE



APPELLATE COURT OF ILLINOIS, FIRST DISTRICT, FOURTH DIVISION

529 N.E.2d 1164, 175 Ill. App. 3d 646, 125 Ill. Dec. 88 1988.IL.1529

Appeal from the Circuit Court of Cook County; the Hon. Thomas E. Hoffman, Judge, presiding.

APPELLATE Judges:

JUSTICE LINN delivered the opinion of the court. JIGANTI, P.J., and McMORROW, J., concur.

DECISION OF THE COURT DELIVERED BY THE HONORABLE JUDGE LINN

Plaintiff, the Attorney General of Illinois, by the relator, the Illinois Department of Public Aid (the Department), brought an action in the circuit court of Cook County against defendant, Irving Hokin, D.D.S. Hokin provided dental services in the Medical Assistance Program, commonly known as Medicaid. Following an administrative hearing, the Department determined that it overpaid Hokin $18,103.58 for his services. In a final administrative decision, the Department terminated Hokin's eligibility to participate in the Medicaid program and declared that he owed the Department that amount.

The Attorney General sought the enforcement of the Department's decision demanding recoupment. The trial court ruled that the complaint failed to state a cause of action as a matter of law. The trial court subsequently, by agreement, dismissed the complaint with prejudice. The Attorney General appeals, contending that the trial court erred in dismissing the complaint.

We reverse the orders of the trial court and remand with directions.

Background

In determining whether to allow a motion to dismiss, a court must take all well-pled allegations of fact contained in the complaint, and in any attached exhibits incorporated into the complaint, as true and construe all reasonable inferences therefrom in the plaintiff's favor. Business Development Services, Inc. v. Field Container Corp. (1981), 96 Ill. App. 3d 834, 836, 422 N.E.2d 86, 89.

The complaint alleged that Hokin provided dental services to Medicaid recipients, as provided by article V of the Illinois Public Aid Code, which the Department administers. (Ill. Rev. Stat. 1987, ch. 23, par. 5-1 et seq.) Between late September and early November of 1981, the Department audited Hokin's billings for services allegedly rendered to Medicaid recipients from September 1978 through December 1979. As a result of this audit, the Department determined initially that it overpaid Hokin $34,597.13. On or about July 27, 1983, the Department notified Hokin by mail that it intended to terminate Hokin's eligibility to participate in the Medicaid program and to recover the $34,597.13.

The Department scheduled an administrative hearing for August 17, 1983. Hokin appeared, but sought a continuance. The hearing officer granted him a continuance on that date and on five subsequent dates. On April 5, 1984, as a result of a reaudit, the Department amended its notice to Hokin, lowering the recoupment amount to $18,103.58. Hokin then withdrew his request for a hearing.

On April 11, 1984, the hearing officer declared Hokin in default under the Department's administrative rules. The hearing officer issued a recommended decision that Hokin's eligibility to participate in the Medicaid program be terminated and that the Department recover from him $18,103.58. On April 27, 1984, the Department's Executive Deputy Director issued a final administrative decision. The Department's final decision adopted the hearing officer's recommendations. The Department terminated Hokin's eligibility to participate in the Medicaid program and declared that Hokin owed the Department $18,103.58.

On September 24, 1986, the Attorney General filed his complaint on behalf of the Department, pursuant to section 12-15 of the Public Aid Code. (Ill. Rev. Stat. 1987, ch. 23, par. 12-15.) He sought a judgment for $18,044.58, plus interest, attorney fees, and costs. Hokin moved to dismiss the complaint. (Ill. Rev. Stat. 1987, ch. 110, par. 2-615.) He argued that the Public Aid Code does not authorize the Department to conclusively determine the amount of overpayments to a Medicaid provider and to enter an administrative order demanding repayment in the nature of a money judgment. Further, since the Department lacked the statutory ...


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