Franklin Plaza Nursing Home v. Lambert

No. 273087 (Ohio C.P. Cuyahoga County Oct. 23, 1995). ; Clearinghouse Number: 50971

Description

Competent Medicare Beneficiary Was Entitled to Personal Notice of Noncoverage for Skilled Nursing Care

Abstract

The court has granted defendant patient summary judgment in this collection action. Shortly after defendant, an 86-year-old man, was admitted to plaintiff nursing home, plaintiff determined that he did not require skilled nursing services and issued a notice of noncoverage for Medicare. Although defendant was fully mentally competent, nursing home mailed the notice using defendant’s home address to defendant’s nephew. Defendant’s Medicaid application was denied, and nursing home sued him for its services until his discharge. Defendant argued that nursing home was precluded from seeking reimbursement because it had not notified him of its noncoverage determination. Although the regulations allow someone other than the beneficiary to receive notice if that other person is acting on the beneficiary’s behalf, defendant argued that his nephew had not been acting on his behalf during the period in question as he was fully mentally competent and did not need a surrogate. Finding that nursing home had not sent notice of noncoverage to defendant and that defendant’s nephew was not an appropriate person to receive such notice, the court barred nursing home from billing defendant for the noncovered services.

Additional Information

Attorney Information
Defendant represented by Sheila Tew, Legal Aid Society of Cleveland, 1223 W. Sixth St., Cleveland, OH 44113, (216) 687-1900 ext. 475.
Docket Date
1995-10-23 00:00:00+00:00