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SOUTH HILLS HEALTH SYSTEM v. COMMONWEALTH PENNSYLVANIA (06/16/86)

decided: June 16, 1986.

SOUTH HILLS HEALTH SYSTEM, PETITIONER
v.
COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, RESPONDENT



Appeal from the Order of the Department of Public Welfare in case of Appeal of: South Hills Health System: Homestead Hospital, St. Joseph's Hospital, File Nos. 32-83-8, 9, 10, 11, 12 and 13, Fiscal Years ending 1971 through 1976, dated January 17, 1985.

COUNSEL

Patrick J. Clair, with him, Frederick A. Boehm, Goehring, Rutter & Boehm, for petitioner.

Bruce G. Baron, Assistant Counsel, for respondent.

Judges Barry and Palladino, and Senior Judge Rogers, sitting as a panel of three. Opinion by Senior Judge Rogers.

Author: Rogers

[ 98 Pa. Commw. Page 184]

The South Hills Health System (petitioner) has filed a petition for review of a final order of the Department of Public Welfare, by its Office of Hearings and Appeals, that the petitioner should pay DPW $7,368 in recoupment of the overpayment of moneys paid to the petitioner in the years ending 1971 through 1976. The petitioner is the successor by consolidation of St. Joseph's Hospital and Homestead Hospital and the alleged overpayments made to those institutions for the care of medical assistance patients.

The Department of the Auditor General had made audits of the two hospitals' claims for reimbursement during the years just mentioned and had decided that their claims with respect to patient days were not justified.

For reasons not clear to us, DPW made no definitive demand for the asserted overpayment until February 16 and 17, 1983. At that time neither the petitioner nor

[ 98 Pa. Commw. Page 185]

    the Commonwealth had any financial records of the events during the years in question. The petitioner had discarded or "retired" its records.*fn1 DPW's records had allegedly been destroyed in a flood.

The petitioner did not appeal the Department of the Auditor General's audit and does not contest the fact that the audit disallowed $7,368 of the hospitals' claims. Its defense is a denial that the hospitals had been paid for the days disallowed in the audit in the first place; thereby putting DPW to proof of payment of the full amounts of their claims. The petitioner contends, and we agree, that one who asserts the existence of certain facts bears the burden of proving them. O'Neill v. Metropolitan Life Insurance Company, 345 Pa. 232, 26 A.2d 898 (1942); Laurelton Center v. L & L Boiler Maintenance Inc., 47 Pa. Commonwealth Ct. 14, 407 A.2d 98 (1979); Hervits v. New York Life Insurance Company, 160 Pa. Superior Ct. 496, 52 A.2d 368 (1947). Since DPW asserts it paid the petitioner in full of its claims, it had the burden of proving that it did.

As we first noted, the final order in the case was that of DPW's Office of Hearings and Appeals. That order consisted of the adoption of the order of the DPW Hearing Officer who conducted an evidentiary hearing and filed a proposed adjudication with findings, discussion, and a conclusion that the DPW's order directing the payment by the petitioner of the overpayment should be upheld. At the hearing DPW adduced the testimony of a field auditor of the Department of the Auditor General to the effect that it was ...


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