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Justices affirm ruling in dispute between health care facility and FSSA

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The Indiana Supreme Court has affirmed the outcome of a case between Family and Social Services Administration and a decertified intermediate care facility, in which the net result was a wash for both sides.

In Randall L. Woodruff, Trustee, U.S. Bankruptcy Court, on Behalf of Legacy Healthcare, Inc.d/b/a New Horizon Develop. Center v. In. Family & Social Serv. Admin., Office of Medicaid Policy & Planning, No. 29S02-1110-PL-598, New Horizon Development Center was certified to receive Medicaid reimbursement from the state. However, an inspection found deplorable conditions and its certification was revoked. The facility operated without receiving federal or state funding for nine months, when the state then appointed a receiver. At issue in the case is whether Legacy Healthcare, which ran the center, is entitled to funding for the care of the patients, after it was decertified, until all the patients could be transferred to other facilities.

The trial court denied restitution for the unpaid months under a theory of quantum meruit, afforded relief under related breach of contract claims, but offset that judgment by the amount the state paid for its receiver. The parties received no net gain. The justices affirmed.

New Horizon couldn’t have reasonably foreseen payment from FSSA for its Medicaid-eligible patients after it was decertified, and the evidence clearly shows that it was aware that decertification would not result in immediate transfer of those patients to other facilities by the state. New Horizon then, can’t succeed as a matter of law in its claim for quantum meruit because it can’t show that it expected payment for any services it might have provided, wrote Chief Justice Randall T. Shepard.

Because FSSA did not have any contractual or equitable obligation to pay the health care costs of the Medicaid-eligible patients at New Horizon during the post-decertification period, there is no bar to the state’s counterclaim for a set-off pursuant to the receivership statutes, wrote Shepard.

The justices did reverse the trial court with respect to its findings on the issue of exhaustion, noting that the facility appealed its decertification through administrative channels and had sought relief in court.

 

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  1. A traditional parade of attorneys? Really Evansville? Y'all need to get out more. When is the traditional parade of notaries? Nurses? Sanitation workers? Pole dancers? I gotta wonder, do throngs of admiring citizens gather to laud these marching servants of the constitution? "Show us your billing records!!!" Hoping some video gets posted. Ours is not a narcissistic profession by any chance, is it? Nah .....

  2. My previous comment not an aside at court. I agree with smith. Good call. Just thought posting here a bit on the if it bleeds it leads side. Most attorneys need to think of last lines of story above.

  3. Hello everyone I'm Gina and I'm here for the exact same thing you are. I have the wonderful joy of waking up every morning to my heart being pulled out and sheer terror of what DCS is going to Throw at me and my family today.Let me start from the !bebeginning.My daughter lost all rights to her 3beautiful children due to Severe mental issues she no longer lives in our state and has cut all ties.DCS led her to belive that once she done signed over her right the babies would be with their family. We have faught screamed begged and anything else we could possibly due I hired a lawyer five grand down the drain.You know all I want is my babies home.I've done everything they have even asked me to do.Now their saying I can't see my grandchildren cause I'M on a prescription for paipain.I have a very rare blood disease it causes cellulitis a form of blood poisoning to stay dormant in my tissues and nervous system it also causes a ,blood clotting disorder.even with the two blood thinners I'm on I still Continue to develop them them also.DCS knows about my illness and still they refuse to let me see my grandchildren. I Love and miss them so much Please can anyone help Us my grandchildren and I they should be worrying about what toy there going to play with but instead there worrying about if there ever coming home again.THANK YOU DCS FOR ALL YOU'VE DONE. ( And if anyone at all has any ideals or knows who can help. Please contact (765)960~5096.only serious callers

  4. He must be a Rethuglican, for if from the other side of the aisle such acts would be merely personal and thus not something that attaches to his professional life. AND ... gotta love this ... oh, and on top of talking dirty on the phone, he also, as an aside, guess we should mention, might be important, not sure, but .... "In addition to these allegations, Keaton was accused of failing to file an appeal after he collected advance payment from a client seeking to challenge a ruling that the client repay benefits because of unreported income." rimshot

  5. I am not a fan of some of the 8.4 discipline we have seen for private conduct-- but this was so egregious and abusive and had so many points of bad conduct relates to the law and the lawyer's status as a lawyer that it is clearly a proper and just disbarment. A truly despicable account of bad acts showing unfit character to practice law. I applaud the outcome.

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