Fillmore v. Dept of Health

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Fillmore v. Dept of Health, Case No. 20010520-CA, Filed November 8, 2001 IN THE UTAH COURT OF APPEALS


Jill Fillmore,
Petitioner and Appellant,


Utah Department of Health,
Division of Health Care Financing,
Respondent and Appellee.

(Not For Official Publication)

Case No. 20010520-CA

November 8, 2001 2001 UT App 340 -----

Original Proceeding in this Court

Jill Fillmore, West Jordan, Appellant Pro Se
Mark L. Shurtleff and Jean P. Hendrickson, Salt Lake City, for Appellee -----

Before Judges Greenwood, Jackson, and Bench.


Appellant Mrs. Fillmore and her family were receiving disability income and medicaid. In calculating the family's qualification for medicaid, the Utah Department of Health, Division of Health Care Financing (DHCF) mistakenly neglected to include Mr. Fillmore's income for four and one half years. Once DHCF realized the mistake, they adjusted the income level and Mrs. Fillmore no longer qualified for medicaid unless the family spent down its income to a level that would qualify. Mrs. Fillmore claimed that equitable estoppel prevented the government from now adjusting her benefits.

Mrs. Fillmore petitions this court to reverse the determination by the agency that equitable estoppel can not be enforced against the government. An appellate court will not disturb the board's application of its factual findings to the law unless its determination exceeds the bounds of reasonableness and rationality. See Nelson v. Department of Emp. Sec., 801 P.2d 158 (Utah Ct. App. 1990); Pro-Benefit Staffing, Inc. v. Board of Review, 775 P.2d 439 (Utah Ct. App. 1989). It is undisputed that the agency overpaid benefits by not taking Mr. Fillmore's income into account.

Estoppel cannot be asserted against a government agency except where doing so does not interfere with underlying government policies or unduly undermine the correct enforcement of a particular law or regulation. See United States v. Browning, 630 F.2d 694, (10th Cir. 1980). Further, "[p]ayments of money from the Federal Treasury are limited to those authorized by statute, and erroneous advice given by a Government employee to a benefit claimant cannot estop the Government from denying benefits not otherwise permitted by law." Office of Personnel Management v. Richmond, 496 U.S. 414, 424; 110 S. Ct. 2465, 2471 (1990). The agency determined that approving estoppel in this case would effectively allow unauthorized payments from the Federal Treasury because, by law, spend down is statutorily required based on the household income. This conclusion does not exceed the bounds of reasonableness and rationality.

Therefore, the agency's determination is affirmed and the petition is denied.

Pamela T. Greenwood,
Presiding Judge

Norman H. Jackson,
Associate Presiding Judge

Russell W. Bench, Judge