Illinois Health Maintenance Guaranty Ass'n v. Shapo

CourtAppellate Court of Illinois
DecidedMarch 31, 2005
Docket1-02-0264, 1-02-0409 thru 0412, 1-02-0686, 1-02-1149 thru 1162, 1-02-1437 thru 1440, 1-02-1443, 1-02-2220, 1-02-2222 thru 2232, 1-02-2233 Cons. Rel
StatusPublished

This text of Illinois Health Maintenance Guaranty Ass'n v. Shapo (Illinois Health Maintenance Guaranty Ass'n v. Shapo) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Illinois Health Maintenance Guaranty Ass'n v. Shapo, (Ill. Ct. App. 2005).

Opinion

SIXTH DIVISION

March 31, 2005

Nos. 1-02-0264 & (1-02-0409, 1-02-0410, 1-02-0411, 1-02-0412, 1-02-0686, 1-02-1149,         1-02-1150, 1-02-1151, 1-02-1152, 1-02-1153, 1-02-1154, 1-02-1155, 1-02-1156, 1-02-1157,    1-02-1158, 1-02-1159, 1-02-1160, 1-02-1161, 1-02-1162, 1-02-1437, 1-02-1438, 1-02-1439,    1-02-1440, 1-02-1443, 1-02-2220, 1-02-2222, 1-02-2223, 1-02-2224, 1-02-2225, 1-02-2226,    1-02-2227, 1-02-2228, 1-02-2229, 1-02-2230, 1-02-2231, 1-02-2232, & 1-02-2233) (Consolidated)

ILLINOIS HEALTH MAINTENANCE GUARANTY

ASSOCIATION,

Plaintiff-Appellant and Cross-Appellee ,

v.

NATHANIEL S. SHAPO, the Director of Insurance of the State of Illinois, THE DEPARTMENT OF INSURANCE, MICHAEL B. NASH, ROYAL B. MARTIN,  OAK PARK HOSPITAL,  PAUL T. ATKENSON, EHS HOSPITALS-SOUTH CHICAGO COMMUNITY HOSPITAL, HARTGROVE HOSPITAL, EHS HOSPITALS-CHRIST HOSPITAL,  RAVENSWOOD HOSPITAL AND MEDICAL CENTER,   LITTLE COMPANY OF MARY HOSPITAL, CHILDREN'S MEMORIAL HOSPITAL,  LOYOLA MEDICAL PRACTICE PLAN, THOREK HOSPITAL AND MEDICAL CENTER,  EHS HOSPITALS- BETHANY HOSPITAL,  SSM REGIONAL HEALTH SERVICES, d/b/a St. Francis Hospital and Health Center,  UNIVERSITY OF CHICAGO PHYSICIANS GROUP,  SOUTH SUBURBAN HOSPITAL,  RUSH-PRESBYTERIAN-ST. LUKE'S HOSPITAL,  ST. JAMES HOSPITAL-CHICAGO HEIGHTS,  WESTSIDE COMMUNITY HOSPITAL, d/b/a Sacred Heart Hospital, WESTLAKE COMMUNITY HOSPITAL, UNIVERSITY OF CHICAGO HOSPITALS, COUNTY OF COOK on behalf of JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY,  ST. BERNARD HOSPITAL, LOYOLA UNIVERSITY MEDICAL CENTER,  WEST SUBURBAN HOSPITAL , and GRANT HOSPITAL,

Defendants-Appellees

(EHS Hospitals - Bethany Hospital,

EHS Hospitals - Christ Hospital, and

EHS Hospitals - South Chicago

Community  Hospital

          Defendants-Appellees and Cross-Appellants).

_______________________________________________

LITTLE COMPANY OF MARY HOSPITAL, COUNTY OF COOK on behalf of JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY , OAK PARK HOSPITAL, GRANT HOSPITAL, LOYOLA MEDICAL PRACTICE PLAN, UNIVERSITY OF CHICAGO PHYSICIANS GROUP, WESTLAKE COMMUNITY HOSPITAL, RUSH-PRESBYTERIAN-ST. LUKE'S MEDICAL CENTER, UNIVERSITY OF CHICAGO HOSPITALS , LOYOLA UNIVERSITY MEDICAL CENTER, EHS HOSPITALS-SOUTH CHICAGO COMMUNITY HOSPITAL, EHS HOSPITALS-CHRIST HOSPITAL, EHS HOSPITALS-BETHANY HOSPITAL, and SSM REGIONAL HEALTH SERVICES D/B/A ST. FRANCIS HOSPITAL AND HEALTH CENTER

Plaintiffs

Defendant

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Appeal from the

Circuit Court of

Cook County

Case Nos: 01 CH 5654, 01 CH 5656, 01 CH 5659, 01 CH 5660, 01 CH 5661, 01 CH 5662, 01 CH 5663, 01 CH 5664, 01 CH 5665, 01 CH 5667, 01 CH 5669, 01 CH 5671, 01 CH 5672, 01 CH 5673, 01CH 5674, 01

CH 5675, 01 CH 5684, 01 CH 5685, 01 CH 5686, 01 CH 5687, 01 CH 5688, 01 CH 5690, 01 CH 5691, and 01 CH 5692   (Consolidated)

Consolidated with:

Case Nos: 01 CH 5597, 01 CH 5598, 01 CH 5599, 01 CH 5600, 01 CH 5602, 01 CH 5605, 01 CH 5606, 01 CH 5613, 01 CH 5614, 01 CH 5615, 01 CH 5616, 01 CH 5617, 01 CH 5618, and 01 CH 5705 (Consolidated)

Honorable

Patrick E. McGann,

Judge Presiding.

JUSTICE O’MARA FROSSARD delivered the opinion of the court:

Plaintiff-appellant, the Illinois Health Maintenance Organization Guaranty Association ("plaintiff" or "Association"), filed 24 complaints for administrative review in the trial court seeking review of decisions issued by Nathaniel Shapo, the Director of the Illinois Department of Insurance (Department).  In those decisions Director Shapo (the Director) found plaintiff liable to health care providers for services rendered by them to enrollees of an insolvent health maintenance organization (HMO) known as MedCare HMO, Inc. (MedCare).  MedCare was the largest HMO insolvency in Illinois state history.  Over the course of approximately six years, the parties took more than 40 depositions, approximately 60 hearings were conducted, and a record of over 12,000 pages was generated.  The record consists of 96 volumes.

The following 24 defendants-appellees are health care providers that provided services to MedCare enrollees: EHS Hospitals-Christ Hospital, EHS Hospitals-South Chicago Community Hospital, EHS Hospitals-Bethany Hospital, University of Chicago Hospitals, Loyola University Medical Center, South Suburban Hospital, Children's Memorial Hospital, St. James Hospital-Chicago Heights, Little Company of Mary Hospital, Oak Park Hospital, Grant Hospital, Loyola Medical Practice Plan, University of Chicago Physician's Group, Westlake Community Hospital, Westside Community Hospital, d/b/a Sacred Heart Hospital, Thorek Hospital and Medical Center, SSM Regional Health Services, d/b/a St. Francis Hospital and Health Center, Hartgrove Hospital, County of Cook on behalf of John H. Stroger, Jr. Hospital of Cook County, Paul T. Atkenson, St. Bernard Hospital, Rush-Presbyterian-St. Luke's Hospital, Ravenswood Hospital and Medical Center, and West Suburban Hospital.

The Director's decisions addressed three separate issues: plaintiff's liability to the providers for services rendered, plaintiff's liability for interest on principal amounts awarded, and the allocation of hearing costs.  The Director found plaintiff liable to 20 of the 24 providers and awarded specific principal amounts but declined to assess interest on those principal amounts.   Based upon the "contract" (or "contracted provider") defense relied upon by plaintiff in motions for summary disposition , the Director did not find plaintiff liable to the following four providers: St. Bernard Hospital, Hartgrove Hospital, St. James Hospital-Chicago Heights, and Thorek Hospital and Medical Center.   The Director assessed  hearing costs against plaintiff as well as these four providers.   Plaintiff's complaints against these four providers seek review of the Director's decision only on the issue of hearing costs.

The trial court consolidated plaintiff's administrative complaints and subsequently dismissed them because plaintiff did not request a rehearing before the Director prior to filing them and thus failed to exhaust its administrative remedies.  The trial court later entered judgments on the Director's awards; those judgments totaled more than $22 million and included prejudgment and post-judgment statutory interest.  

Plaintiff appeals the dismissal of its 24 complaints, contending the trial court refused to consider its underlying claims by improperly applying the exhaustion doctrine.

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