[WSBAPT] Nursing Home Claim

[Jeff Crollard]

You’re welcome Amy.  Good luck!

Jeff

Crollard Law Office, PLLC
336  36th Street, # 436
Bellingham, WA 98225
Phone:  425-864-1710
jbc at crollardlaw.com<mailto:jbc at crollardlaw.com>

This email is confidential and may contain information or documents that are protected by attorney-client, work product, or other privileges.  If you are not the intended recipient, any dissemination, use or reliance upon its contents is prohibited.  If you received this email in error, please notify me and then delete the email and any attachments.

From: wsbapt-bounces at lists.wsbarppt.com <wsbapt-bounces at lists.wsbarppt.com> On Behalf Of Amy Goertz
Sent: Tuesday, October 22, 2024 11:34 AM
To: WSBA Probate & Trust Listserv <wsbapt at lists.wsbarppt.com>
Subject: Re: [WSBAPT] Nursing Home Claim

Thank you so much, Jeff. This is immensely helpful.

Amy



On Oct 21, 2024, at 3:51 PM, Jeff Crollard <jbc at crollardlaw.com<mailto:jbc at crollardlaw.com>> wrote:

Hello Amy,

The answer to some of your questions may be in  WAC 388-97-0300:<https://app.leg.wa.gov/WAC/default.aspx?cite=388-97-0300>

Subsection (1)(e) says:  “(1) The nursing home must provide the resident, before admission, . . . both orally and in writing and in language and words that the resident understands, with the following information: . . . (e) Items, services and activities available in the nursing home and of charges for those services, including any charges for services not covered under medicare or medicaid or by the home's per diem rate.”

Subsection (7)(b) says:  “(7) The nursing home must furnish a written description of legal rights which includes: . . .(b) In the case of a nursing facility only, a description of the requirements and procedures for establishing eligibility for medicaid, . . . .”

Subsection (9) says:  “(9) The skilled nursing facility and nursing facility must prominently display in the facility written information, and provide to residents and individuals applying for admission oral and written information, about how to apply for and use medicare and medicaid benefits, and how to receive refunds for previous payments covered by such benefits.”

[FYI, the term “skilled nursing facility” refers to Medicare certification.  The term “nursing facility” refers to Medicaid certification.  Most nursing homes have both.]

You say there are adult sons.  If one or more had a POA or otherwise were surrogate decision makers, then they too should have been informed.  The main laws setting forth who’s the resident’s surrogate decision maker is here  WAC 388-97-0240:<https://app.leg.wa.gov/WAC/default.aspx?cite=388-97-0240>  and here  RCW 70.129.010: Definitions.<https://app.leg.wa.gov/RCW/default.aspx?cite=70.129.010>

It’s hard to imagine that the nursing home and home care agency did not send out any billing.  The PR can and should request a copy of the billing, the admission contracts, and the facility’s written info complying with WAC 388-97-0300.

The facility will argue unjust enrichment and breach of contract if she didn’t pay.  The sons may be able to counter with a collateral estoppel type argument, if they weren’t notified and justifiably relied upon the facility promises.  It would help if you can show she likely would have qualified for Medicaid had the application been filed.  You may be able to get the claim denied or negotiated down.

Jeff

Crollard Law Office, PLLC
336  36th Street, # 436
Bellingham, WA 98225
Phone:  425-864-1710
jbc at crollardlaw.com<mailto:jbc at crollardlaw.com>

This email is confidential and may contain information or documents that are protected by attorney-client, work product, or other privileges.  If you are not the intended recipient, any dissemination, use or reliance upon its contents is prohibited.  If you received this email in error, please notify me and then delete the email and any attachments.

From: wsbapt-bounces at lists.wsbarppt.com<mailto:wsbapt-bounces at lists.wsbarppt.com> <wsbapt-bounces at lists.wsbarppt.com<mailto:wsbapt-bounces at lists.wsbarppt.com>> On Behalf Of Amy Goertz
Sent: Monday, October 21, 2024 12:23 PM
To: WSBA Probate & Trust Listserv <wsbapt at lists.wsbarppt.com<mailto:wsbapt at lists.wsbarppt.com>>
Subject: [WSBAPT] Nursing Home Claim

Good morning -

I have a small estate with a 72 yr old woman decedent.  She had a home with a mortgage and a DSHS lien ($20k) so the total estate is just over $120k.

We received a creditor claim of $110k from a law firm in Arizona representing a Spokane nursing home. Here is a quick timeline.


10/13/22 - Spokane woman on Part C Medicare Advantage plan enters Franklin Hills Health and Rehab in Spokane.

8/21/23 - Discharged to home with Generations Home Care Spokane (arranged by Franklin Hills).

9/4/23 - Taken from home to Providence Sacred Heart Hospital Spokane.

9/24/23 - Dies in the Hospital.

Adult sons say the Nursing home told them several times they were going to get her on Medicaid. They never did.

Small law firm out of Arizona files a Creditor Claim asking for $89,750 for Franklin Hills care from 12/10/22 - 8/21/22 and $14,078.57 for Generations Home Care from 8/21/22 - 9/4/22.
The billing they submitted did not show any payments made or any Medicaid status.

Franklin Hills was in the process of either going bankrupt or being bought out during the time she was a patient and the boys said the office was empty most of the time and no one could seem to answer any questions re: billing.

The sons tell me there was never a single bill sent out during all that time. They were told that Franklin Hills had their mom fill out paperwork for presumably Medicaid for payment and that was the last they ever heard about it.

The house is sold and there is some money in the Estate account now however there is close or not enough in the Estate to pay these bills.

Any thoughts about the nursing home failing to get her on Medicaid or send out billings prior to her passing?

Amy

Amy J. Goertz, J.D.
Goertz & Lambrecht PLLC
amyjgoertz at icloud.com<mailto:amyjgoertz at icloud.com>

1.888.926.2607 phone
1.877.684.1627 fax
Address for correspondence:
2829 S. Grand Blvd., Suite 303
Spokane, WA 99203

Additional office locations:
510 Bell Street
Edmonds, WA 98020

Goertz & Lambrecht PLLC
www.goertzlambrecht.com<http://www.goertzlambrecht.com/>








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