Dana Herra Jun. 28, 2016, 11:58am

A state appellate court upheld a lower court’s decision that a doctor’s inability to participate in Medicaid was not adequate grounds for a state licensing agency to suspend his license.

According to background provided in the order issued June 10 by a three-justice panel of the Illinois First District Appellate Court , the Illinois Department of Healthcare and Family Services in 2011  terminated the ability of physician and surgeon Howard Martin to participate in the state’s Medicaid program. This prevented Martin from receiving reimbursement from the state for treating Medicaid patients.

In 2013, the Illinois Department of Financial and Professional Regulation indefinitely suspended Martin’s license to practice medicine, holding that the termination of his participation in Medicaid was “disciplinary action of another state or jurisdiction against a license or other authorization to practice as a medical doctor,” which provided grounds for the suspension. After an administrative hearing, the director of the department executed the suspension. Martin filed a complaint for administrative review by a trial court, and the court reversed the suspension. On appeal, the appellate court upheld the ruling.

The courts found the Department of Healthcare and Family Services is not a “jurisdiction” under the statute the Department of Financial and Professional Regulation cited.

“The term ‘jurisdiction’ is not defined in the statute, but the plain and ordinary meaning of that term is a ‘geographic area within which political or judicial authority may be exercised,’ or a ‘political or judicial subdivision within such an area,’” the justices wrote in the appellate court order.

The department disputed that conclusion, pointing out that later in the statute the phrase “another licensing jurisdiction” is followed by a parenthetical phrase specifying a U.S. state or territory or a foreign state or country. If the word had a consistent meaning throughout the statute, the legislature would not have included the parenthetical, the department argued. The justices shot back that the parenthetical falls far short of the statutory requirement that changing the meaning of a word requires a “clearly expressed” legislative intent.

The state also argued that between the time the department initiated proceedings against Martin and the time the suspension was ordered, the relevant section of the statute had been amended, with the amended version taking effect on Dec. 30, 2014. The amendment, which allows the department to suspend a medical license based upon an “adverse action taken by another state or jurisdiction” includes “adverse action taken by a state agency that prohibits a medical doctor from providing services to the agency’s participants.”

The justices replied that the department’s complaint against Martin and his administrative hearing were held before the amendment took effect, and the suspension took place just weeks after the effective date, not allowing Martin adequate notice or information to prepare his defense.

The justices also repeated their assertion that DHFS is not a jurisdiction, and said his termination from the Medicaid program did not prohibit him from providing services to Medicaid patients; it only prevented him from being reimbursed by Medicaid.

The unpublished order was filed under Supreme Court Rule 23, limiting its use as precedent.

Justice Mathias W. Delort delivered the judgment of the court, and Justices Mary K. Rochford and Thomas E. Hoffman concurred.

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