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COMMONWEALTH PENNSYLVANIA v. ALLEN SOFFER (07/27/88)

decided: July 27, 1988.

COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, PETITIONER
v.
ALLEN SOFFER, O.D., RESPONDENT



Appeal from the Order of the Board of Claims in the case of Allen Soffer, O.D. v. Commonwealth of Pennsylvania, Department of Public Welfare, No. 819-P.

COUNSEL

Bruce G. Baron, Assistant Counsel, for petitioner.

Michael P. Gottlieb, with him, Paul C. Vangrossi, for respondent.

Judges MacPhail and Smith, and Senior Judge Barbieri, sitting as a panel of three. Opinion by Judge MacPhail.

Author: Macphail

[ 118 Pa. Commw. Page 181]

In this appeal, the Department of Public Welfare (DPW) contends, for various reasons, that the Board of Claims (Board) erred when it awarded Dr. Allen Soffer the sum of $13,651.00 together with interest as reimbursement for services rendered to qualified participants in the Pennsylvania Medical Assistance Program.

Dr. Soffer is an optometrist who executed an outpatient provider agreement with DPW in December of 1979. Thereafter, invoices were submitted to DPW by his office. Many were rejected for various reasons and they are at issue here. The record indicates that many efforts were made by Dr. Soffer's office to ascertain from DPW why the invoices were rejected and how they might be correctly resubmitted. These efforts culminated in a visit by representatives from DPW to the doctor's office on November 3, 1981 for the purpose of educating his staff on proper billing procedures.

It is provided in 55 Pa. Code § 1101.68 that invoices submitted to DPW after 180 days will be rejected unless certain exceptions, which are not in evidence here, apply. On December 26, 1980, Medical Assistance Bulletin No. 99-80-15 was issued by DPW. That bulletin provided that rejected invoices could be resubmitted within 180 days of the date of rejection.*fn1 DPW refused

[ 118 Pa. Commw. Page 182]

    to pay the invoices at issue here because they were beyond the 180-day limitation for resubmission.

Dr. Soffer filed his claim with the Board on July 12, 1982. DPW filed an answer with new matter alleging that Dr. Soffer's claim accrued on or before November 3, 1981 and that, since it was filed more than six months beyond that date, the Board lacked jurisdiction. Section 6 of the Act of May 20, 1937, P.L. 728, as amended, 72 P.S. § 4651-6. DPW also contended before the Board and argues here as well that the claim is barred because the Board has no jurisdiction over disputes of this nature; rather, DPW argues that Dr. Soffer should have pursued his claim before DPW as a statutory appeal.

In its findings of fact, the Board stated that the doctor's claim accrued on November 3, 1981, but the Board also concluded as a matter of law that DPW was estopped from raising the bar of the six-month statute of limitations. The Board found that representatives of DPW misled and misrepresented to the doctor's billing personnel that disputed invoices could be resubmitted after proper instruction from DPW was given. The Board's opinion stated that these misrepresentations were relied upon by the doctor to his detriment. Since there was no dispute that the services were rendered and the amount due was stipulated, the Board awarded the doctor the full amount of his claim.

In Governor's Energy Council v. American Energy Services, Inc., 90 Pa. Commonwealth Ct. 168, 172, 494 A.2d 72, 74 (1985), appeal dismissed, 515 ...


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