Mykytiuk v. Hamos
| Citation | 2014 IL App (1st) 123507 -U |
| Decision Date | 17 November 2014 |
| Docket Number | No. 1-12-3507,1-12-3507 |
| Parties | LARYSA MYKYTIUK, Plaintiff-Appellant, v. JULIE HAMOS, Director, the Illinois Department of Healthcare and Family Services, Defendant-Appellee. |
| Court | United States Appellate Court of Illinois |
NOTICE: This order was filed under Supreme Court Rule 23 and may not be cited as precedent by any party except in the limited circumstances allowed under Rule 23(e)(1).
Appeal from the Circuit Court of Cook County.
Honorable Mary Anne Mason, Judge Presiding.
¶ 1 Held: Administrative law judge of the Illinois Department of Healthcare and Family Services abused his discretion in denying plaintiff's motion to file a third-party complaint to join necessary parties; plaintiff's due process rights were violated; judgment reversed.
¶ 2 This appeal arises from the October 24, 2012 order entered by the circuit court of Cook County, which affirmed the administrative decision of defendant-appellee Director Julie Hamos (the Director) of the Illinois Department of Healthcare and Family Services (DHFS), to terminate plaintiff-appellant Dr. Larysa Mykytiuk (Dr. Mykytiuk)'s eligibility to participate in the IllinoisMedical Assistance Program and to recover the sum of $533,828.38 in overpayments made by DHFS. On appeal, Dr. Mykytiuk argues that: (1) the Director erred in refusing to find that certain relevant patient "sign-in" sheets satisfied Dr. Mykytiuk's obligation to produce patient records during an audit conducted by DHFS; (2) requiring her to reimburse $533,828.38 in overpayments by DHFS violated public policy; (3) the Director and the administrative law judge erred in denying her motion to join certain necessary third parties to the administrative action; and (4) the Director's decision to terminate her from the Illinois Medical Assistance Program violated the Illinois Administrative Code and her due process rights. For the following reasons, we reverse the judgment of the circuit court of Cook County and therefore the judgment of the administrative tribunal.
¶ 4 Dr. Mykytiuk is a public service physician who specializes in pediatrics and has received extra training in psychiatry. In August 2004, Dr. Mykytiuk entered into a provider agreement with DHFS by which she agreed to provide medical treatment to patients who were recipients of public aid in the Illinois Medical Assistance Program—also known as the Medicaid program. As a provider or "vendor" in the state's Medicaid program, covered medical services rendered to Medicaid patients by Dr. Mykytiuk were paid by DHFS. Pursuant to the provider agreement with DHFS, Dr. Mykytiuk agreed, "on a continuing basis, to comply with all current and future program policy and billing provisions" as set forth in the DHFS handbooks, and "to be fully liable for the truth, accuracy and completeness of all claims submitted *** to [DHFS] for payment." Dr. Mykytiuk also agreed "to furnish to [DHFS] or its designee upon demand all records associated with submitted claims necessary to disclose fully the nature and extent of services provided to individuals under the [Medicaid] program and maintain said records for notless than three (3) years from the date of service ***." Dr. Mykytiuk further agreed to be "fully liable to [DHFS] for any overpayments."
¶ 5 Under separate agreements with DHFS in 2004 and 2005, Dr. Mykytiuk designated as "alternate payees" the following three medical facilities where she was employed: (1) 26th Street Medical, S.C. (26th Street Medical); (2) Hyssop Modification Services, Inc. (Hyssop); and (3) Solid Rock Care Center (Solid Rock). The alternate payee agreements stated that the medical practitioner "shall be responsible for the accuracy and truthfulness of all bills submitted on behalf of the practitioner" and that the practitioner "understands and acknowledges that it is his or her personal responsibility to review any and all billings before such billings are submitted to [DHFS] on practitioner's behalf and/or in his or her name." In conjunction with the execution of the alternate payee agreements with DHFS, Dr. Mykytiuk also granted powers of attorney to Hyssop and Solid Rock. Under the powers of attorney, Dr. Mykytiuk acknowledged that the granting of such powers "in no way limits [her] rights, liabilities or duties relating to the provision of services under [DHFS]'s [Medicaid] program," and that she retained "full responsibility for all claims submitted to [DHFS]" under her name. By executing the powers of attorney agreements, Dr. Mykytiuk also acknowledged that "the person appointed must be a trusted employee over whom [she] [has] direct supervision on a daily basis." During her tenure at Hyssop and Solid Rock, Dr. Mykytiuk led group therapy sessions primarily for mentally ill nursing home residents. She worked as a pediatrician for 26th Street Medical. In December 2007, Dr. Mykytiuk quit her job at Hyssop.
¶ 6 In a letter dated September 3, 2008, DHFS notified Dr. Mykytiuk that she had been selected for the auditing process with regard to payments made by DHFS for medical services provided by Dr. Mykytiuk as a vendor of the Medicaid program. The stated purpose of the auditwas to determine whether Dr. Mykytiuk complied with DHFS policies with regard to billings made to DHFS between September 1, 2005 and August 31, 2007—during which DHFS paid bills under Dr. Mykytiuk's provider number for 613 Medicaid recipients.
¶ 7 In 2009, an audit was performed by DHFS' Bureau of Medicaid Integrity (the Bureau), which examined bills totaling $304,098.47 from a sample size of 241 out of 613 Medicaid recipients. Results of the audit revealed that, within the audit sample, DHFS overpaid1 $209,873.80 on claims submitted under Dr. Mykytiuk's provider number for medical services provided to Medicaid patients between September 1, 2005 and August 31, 2007. Specifically, 945 cases of overpayment pertained to "missing patient records"; 4,958 cases of overpayment pertained to "missing records of specific services"; 55 cases of overpayment related to "improper procedure code billing"; 283 cases of overpayment related to "non-covered services"; and 8 cases of overpayment "due to billing for services performed by another provider." Subsequently, Dr. Mykytiuk requested a re-audit by DHFS. A re-audit was performed and the results of the re-audit again revealed that DHFS overpaid $209,873.80 on claims submitted under Dr. Mykytiuk's provider number. Specifically, the re-audit found 22 cases of overpayment "due to missing patient records"; 5,881 cases of overpayment "due to missing records of specific services"; 55 cases of overpayment "due to improper procedure code billing"; 283 cases of overpayment "due to billing for non-covered services"; and 8 cases of overpayment "due to billing for servicesperformed by another provider." DHFS then extrapolated the $209,873.80 of overpayments beyond the sample size and projected a total recoupment amount of $533,828.38.
¶ 8 On May 5, 2010, the Office of Inspector General of DHFS issued a "notice of right to hearing" to Dr. Mykytiuk, which stated the agency's intent to terminate her participation in the Medicaid program and to recover the $533,828.38 in overpayments made by DHFS to the alternate payees under her provider number. A "statement of grounds" attached to the notice detailed DHFS' charges against Dr. Mykytiuk, including instances where she "billed for, and was erroneously or improperly paid for, services." Thereafter, Dr. Mykytiuk requested a hearing on the matter and administrative proceedings commenced.
¶ 9 On August 5, 2010, Dr. Mykytiuk, who was represented by counsel, filed a "motion to file third-party complaint," seeking to join as parties Hyssop and Andrew Griffin, Sr. (Griffin), individually and as owner and operator of Hyssop, in the administrative proceedings against her. Dr. Mykytiuk alleged that Hyssop and Griffin were necessary parties because they were solely responsible for billing DHFS and had received payments from DHFS as an alternate payee under her provider number; and that they refused to produce patient records or cooperate with Dr. Mykytiuk during the auditing process. On September 15, 2010, DHFS filed an objection opposing Dr. Mykytiuk's motion to join Hyssop and Griffin as necessary third parties, arguing that Hyssop and Griffin were not necessary to the administrative proceedings because Dr. Mykytiuk was liable to DHFS for the overpayments regardless of Hyssop and Griffin's conduct. DHFS' objection further noted that the proper venue for any action by Dr. Mykytiuk against Hyssop and Griffin would be in the circuit court, presumably in a separate proceeding, rather than in the then current administrative hearing.
¶ 10 On October 14, 2010, at a hearing on Dr. Mykytiuk's motion to file the third-party complaint against Hyssop and Griffin, the administrative law judge (ALJ) denied the motion. The ALJ noted that DHFS' rules provide for the issuance of subpoenas to compel the production of documents and to compel the appearance of individuals and entities. The ALJ found that the addition of Hyssop and Griffin as third parties in the case would have no material impact on the ultimate underlying issue in the case—that is, whether Dr. Mykytiuk's participation in the Medicaid program should be terminated and whether funds should be recovered from her by DHFS.
¶ 11 On November 3, 2010, an evidentiary hearing commenced during which DHFS presented the testimony of DHFS auditor Hope Little (Little). Little testified that she worked as an auditor for the Bureau within DHFS. She testified to the audit and re-audit of Dr. Mykytiuk's records in the instant case, which she had personally conducted. Little stated that the purpose of an audit is to determine compliance with DHFS rules. Little explained DHFS' audit procedures, the...
To continue reading
Request your trial