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COMMONWEALTH PENNSYLVANIA v. LEONARD H. SHAPIRO (08/09/85)

decided: August 9, 1985.

COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, PETITIONER
v.
LEONARD H. SHAPIRO, M.D., RESPONDENT



Appeal from the Order of the Board of Claims in the case of Leonard H. Shapiro, M.D. v. Commonwealth of Pennsylvania, Department of Public Welfare, Docket No. 726.

COUNSEL

Bruce G. Baron, Assistant Counsel, for petitioner.

Richard C. Senker, for respondent.

Judges MacPhail and Colins, and Senior Judge Blatt, sitting as a panel of three. Opinion by Judge MacPhail.

Author: Macphail

[ 91 Pa. Commw. Page 65]

The Department of Public Welfare (DPW) appeals from a decision of the Board of Claims (Board) awarding Dr. Leonard H. Shapiro (Claimant) $2,000.00 together with interest at 6% per annum beginning June 2, 1980. We reverse the order of the Board of Claims.

Claimant was a provider in the Pennsylvania Medical Assistance Program (Program) who performed therapeutic abortions for persons who were eligible for Program benefits during the years 1972 through 1975. On or about January 16, 1979, Claimant notified DPW that he had submitted invoices to DPW for 241 patients who had received therapeutic abortions and for which he had not been paid. On March 14, 1980, Claimant was advised that DPW would honor invoices submitted for abortion services performed October 9, 1973 through June 20, 1977 and that invoices for abortions performed prior to October 9, 1973 would be denied. On March 24, 1980, Claimant's counsel requested a DPW decision on 65 claims allegedly submitted to DPW for abortions performed within the prescribed time frame. DPW responded

[ 91 Pa. Commw. Page 66]

    on June 2, 1980 by advising Claimant that it would honor some of the claims but that reimbursement for 40 cases listed by name and Program number were denied because DPW had no record of any claim having been submitted by Claimant for those cases. Claimant's counsel sent a letter to DPW on July 21, 1980 stating that DPW's refusal to pay for the services rendered was illegal. DPW never responded to that letter.

On January 12, 1981, Claimant filed a statement of claim with the Board demanding, inter alia, payment for 62 unpaid invoices. DPW filed preliminary objections which were sustained in part and overruled in part. The Board, in disposing of the preliminary objections, held that the DPW letters of March 14 and June 2, 1980 advised Claimant of the status of each of the cases about which Claimant was concerned. The Board went on to hold that all of Claimant's claims except the 40 cases which DPW said were not billed to DPW, were time barred by virtue of the provisions of Section 6 of the Act of May 20, 1937, P.L. 728, as amended, 72 P.S. ยง 4651-6, which states that the Board has no jurisdiction over a claim filed more than six months after it accrues.

As to the remaining 40 cases, however, the Board held that "DPW's inability to locate records does not necessarily mean that those records do not exist and, therefore, the plaintiff is not barred from presenting claims for services performed because records cannot be located."

DPW then filed an answer to the statement of claim containing new matter which set forth, inter alia, that Claimant's failure to appeal from the determinations made by DPW on March 14 and June 2, 1980 disallowing the Claimant's claims, was a bar to ...


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