In re M.P.

(SSA Office of Hearings & App. Oct. 11, 1996). ; Clearinghouse Number: 51607

Description

Nursing Home Ordered to Absorb Care Costs Because It Failed to Give Written Notice of Noncoverage by Medicare

Abstract

The administrative law judge (ALJ), on remand from the Appeals Council, has ordered nursing facility to absorb the cost of beneficiary’s care because it did not give written notice of noncoverage. Beneficiary was admitted to nursing home after hospital treatment for a cerebrovascular accident. For some three months he stayed in the facility, where he received skilled nursing and rehabilitation services daily for about three weeks. At the administrative hearing a doctor testified that patient’s condition plateaued approximately two months before he was released, and the ALJ concluded that patient did not require or receive daily skilled services for most of the stay. About three weeks before beneficiary’s condition plateaued, nursing provider told him in person that services beginning a few weeks later would not be covered by Medicare Part A, but written notice of noncoverage was not received by beneficiary or his wife. At issue was who was responsible for the cost of care after beneficiary’s condition plateaued. The ALJ ordered provider to absorb the costs of the noncovered services because written notice was not given to beneficiary and because provider knew or should have known that the services were not covered.

Additional Information

Attorney Information
Claimant represented by Edward M. Dale, Elder Law & Legal Assistance to Medicare Patients, Connecticut Legal Services, Inc., 872 Main St., P.O. Box 258, Willimantic, CT 06226-0258; (860) 423-2556.
Docket Date
1996-10-11 00:00:00+00:00