Summary 2009 WY 138

Summary of Decision issued November 10, 2009

Summaries are prepared by Law Librarians and are not official statements of the Wyoming Supreme Court.

Case Name: Burke v. State, DOH

Citation: 2009 WY 138

Docket Number: S-09-0022

Appeal from the District Court of Laramie County, the Honorable Michael K. Davis, Judge.

Representing Appellant Burke: Frank J. Jones, Wheatland, Wyoming.

Representing Appellee State: Bruce A. Salzburg, Wyoming Attorney General; Robin Sessions Cooley, Deputy Attorney General; Douglas J. Moench, Senior Assistant Attorney General; Michael T. Kahler, Assistant Attorney General, Shaun Wilkerson, Assistant Attorney General.

Facts/Discussion: After an audit showed that Burke had been excessively reimbursed for services provided to Medicaid recipients, the Department sought reimbursement from him. Burke filed a request for an administrative hearing, but later withdrew the request and the Department dismissed the administrative action. The Department then filed an action in district court to recover the excess payments. The district court entered summary judgment against Burke finding that he was barred from disputing the claim because he failed to exhaust his administrative remedies.

Application of res judicata: Burke was entitled to an administrative hearing. The Department advised him that he was so entitled. Burke requested a hearing and then withdrew his request. His contention that the district court improperly applied res judicata when the Medicaid rules did not allow him to request an administrative hearing was without merit. The Department’s letters clearly informed Burke that the Department was seeking recovery of excess payments pursuant to Chapter 39 and that he had a right to request reconsideration of the decision to recover excess payments, and upon the Department’s issuance of a final decision, a contested case hearing.
Wyoming Medicaid rules: Burke claimed the Medicaid Rules were ambiguous and inconsistent because while the overpayment and excess payment provisions allow a provider to request an administrative hearing, both provisions also allow the Department to initiate a civil action to recover the payments even when the provider has requested a hearing. The problem with Burke’s argument was that there was no administrative proceeding at the time the civil lawsuit was filed. Consequently, there was no possibility of an administrative ruling in his favor and a simultaneous district court judgment in the Department’s favor.
Discovery: The issue before the district court was whether the Department was entitled to judgment as a matter of law on its complaint for money damages against Burke in the amount of the excess payments. The district court determined that the order dismissing the agency action was final. The district court further determined that the doctrine of res judicata applied to bar re-litigation of the claims raised in the administrative proceeding. The discovery Burke sought to pursue was not necessary to a determination of the issues before the district court.

Conclusion: The Department’s letters clearly informed Burke that the Department was seeking recovery of excess payments pursuant to Chapter 39 and that he had a right to request reconsideration of the decision to recover excess payments, and upon the Department’s issuance of a final decision, a contested case hearing. There was no administrative proceeding at the time the civil lawsuit was filed consequently; there was no possibility of an administrative ruling in his favor and a simultaneous district court judgment in the Department’s favor. The discovery Burke sought to pursue was not necessary to a determination of the issues before the district court.

Affirmed.

J. Kite delivered the decision.

Link: http://tinyurl.com/ykmvj5z .

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