691 S.W.3d 831
Tex.2024Background
- Image API, LLC provided document processing services to the Texas Health and Human Services Commission (HHSC) from 2009–2015, under a contract supporting Medicaid and other benefits programs.
- HHSC’s contract with Image permitted retrospective cost settlements, including annual and monthly audits to reconcile payments based on Image’s actual allowable costs.
- The Texas Human Resources Code § 32.0705 requires HHSC to contract for independent, annual audits of Medicaid contractors, with audits to be completed by the end of the fiscal year following the audit year.
- In 2016, HHSC audited Image’s 2010–2011 performance and found overpayments; Image cooperated with the untimely audit but disputed HHSC’s authority due to the statutory deadline.
- Image sued, seeking to enjoin HHSC from using audit results from untimely audits; the court of appeals dismissed Image's entire suit, holding the audit deadline was directory, not mandatory; Image sought Supreme Court review.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Image is a Medicaid contractor under § 32.0705 | Image provides administrative services related to Medicaid eligibility, so qualifies as a contractor. | Image's services are not sufficiently managerial to be a "Medicaid contractor." | Image is a Medicaid contractor under § 32.0705. |
| Whether § 32.0705(d)'s audit deadline is mandatory or directory | "Must be completed" is mandatory; late audits are ultra vires and not allowed. | Deadline is directory due to lack of enforcement penalty; agency needs flexibility. | Deadline is mandatory, not merely directory. |
| Consequence of missing the audit deadline | Untimely audits are void; HHSC cannot recoup overpayments found in late audits. | No specific penalty, so HHSC can still use audit results and recover overpayments. | No textual or necessary consequence; HHSC can use the result and recoup. |
| Prospect for future untimely audits | HHSC should be enjoined from future untimely audits. | NA (not yet adjudicated) | Remanded to trial court to address Image’s prospective relief claims. |
Key Cases Cited
- Hall v. McRaven, 508 S.W.3d 232 (Tex. 2017) (describing ultra vires actions by state officials as exception to immunity)
- City of El Paso v. Heinrich, 284 S.W.3d 366 (Tex. 2009) (allowing suits against state officials for ultra vires acts)
- Chem. Lime, Ltd. v. Edwards Aquifer Auth., 291 S.W.3d 392 (Tex. 2009) (distinguishing mandatory vs. directory statutory language and consequences)
- AC Interests, L.P. v. Texas Commission on Environmental Quality, 543 S.W.3d 703 (Tex. 2018) (describing statutory deadlines as mandatory absent explicit/necessary consequences for violations)
- Chisholm v. Bewley Mills, 287 S.W.2d 943 (Tex. 1956) (guidance on distinguishing directory vs. mandatory statutory language)
