Alberico v. Health Management Systems, Inc.

5 P.3d 967, 2000 Colo. J. C.A.R. 3674, 2000 Colo. App. LEXIS 1087, 2000 WL 796608
CourtColorado Court of Appeals
DecidedJune 22, 2000
Docket99CA0800
StatusPublished
Cited by5 cases

This text of 5 P.3d 967 (Alberico v. Health Management Systems, Inc.) is published on Counsel Stack Legal Research, covering Colorado Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alberico v. Health Management Systems, Inc., 5 P.3d 967, 2000 Colo. J. C.A.R. 3674, 2000 Colo. App. LEXIS 1087, 2000 WL 796608 (Colo. Ct. App. 2000).

Opinion

Opinion by

Judge RULAND.

In an action to determine the validity of certain 'real estate liens, plaintiff, Edward Alberico, appeals from the summary judgment in favor of defendants, Health Management Systems, Inc., (HMS) and the Colorado Department of Health Care Policy and Financing (DHF). We affirm.

As pertinent here, DHF is the state agency charged with administrating the Colorado Medical Assistance Act (CMAA), § 264-101, et seq., C.R.§8.1999. See § 26-4-104(1), C.R.S.1999. Pursuant to a contract with DHF, HMS assists in obtaining reimbursement for medical assistance payments made to Medicaid recipients.

In 1992, plaintiff's mother began residing in a nursing home. To qualify for Medicaid assistance, it was necessary that she have less than $2,000 in resources. However, the mother's primary residence was properly excluded in calculating the $2,000 resource requirement. See 42 U.S.C. § 18382b(a)(1)(2000); Department of Health Care Policy & Financing § 3.220.28, 9 Colo. Code Reg. 2503-1. DHF determined that plaintiff's mother was eligible and began paying her benefits.

In 1998, acting pursuant to a power of attorney, plaintiff conveyed his mother's residence by quitclaim deed to an inter-vivos revocable trust for nominal consideration. His mother was the initial beneficiary of the trust. Plaintiff recorded the deed, but neither plaintiff nor his mother informed DHF of the transfer. At that time, DHF had paid in excess of $16,000 in benefits on behalf of the mother. DHF continued to pay benefits following the conveyance.

In March of 1994, an attending physician determined that plaintiff's mother could not reasonably expect to return to her home to live. Accordingly, DHF directed HMS to file a lien on the mother's residence to secure reimbursement for benefits paid. HMS did so, and then it continued to file updated liens as additional benefits accrued. During this time, plaintiff periodically completed applications for benefits on behalf of his mother. However, he failed to disclose the transfer of the residence notwithstanding the written re *969 quirement on the application forms that he "report any changes ... in resources, etc. as soon as they happen."

At her death in 1996, Medicaid payments on behalf of plaintiffs mother exceeded $100,000. The residence was sold and $112,839 of the proceeds was placed in escrow pending resolution of the issues in this case.

Plaintiff commenced this action seeking a determination that defendants' liens were invalid. Plaintiff also brought a tort claim against HMS for interference with his inheritance. Defendants filed counterclaims requesting that their liens be declared valid and enforceable.

Following submission of eross-motions for summary judgment, the trial court granted judgment in favor of defendants on the basis that the conveyance of the residence was void as to defendants under § 38-10-111, C.R.S. 1999. On this basis, the court ruled that DHF'"s liens were valid. The court also granted defendants' motion to dismiss plaintiffs tort claim. On appeal, plaintiff challenges only the trial court's ruling on the validity of the liens.

In resolving the issues on appeal, we must independently review the record and evaluate the motions for summary judgment in the same manner as the trial court. See Aspen Wilderness Workshop, Inc. v. Colorado Water Conservation Board, 901 P.2d 1251 (Colo.1995). Entry of summary judgment is proper if, as here, there are no disputed issues of material fact, and the only issues for decision present legal questions. See Kaiser Foundation Health Plan v. Sharp, 741 P.2d 714 (Colo.1987).

I.

Plaintiff contends that the trial court erred in its ruling because, he argues, defendants' liens were invalid under the applicable federal statute and regulations. Specifically, plaintiff asserts that his mother became ineligible for Medicaid payments as a result of the conveyance of her residence to the trust. According to plaintiff, in order to enforce any lien based upon ineligibility, defendants were required first to obtain a court judgment to recover "incorrect payments" under 42 U.S.C. § 1896p(a)(1)(A)(2000).

Defendants respond that the liens are valid to secure repayment of benefits under 42 U.S.C. § 1896p(a)(1)(B)(2000) because the transfer of the property into the trust was void as to them under § 38-10-111. Hence, they argue the benefits were correctly paid under the federal statute. We agree with defendants and the trial court's ruling.

States participating in the federal Medicaid program must comply with certain federal requirements. See 42 U.S.C. § 19862 (2000). Colorado participates in Medicaid pursuant to the CMAA. See § 26-4-101, et seq.

Under the Medicaid program, the residence of a beneficiary formerly could lose its exempt status and become a countable resource if it was transferred into a trust as defined in the former version of 42 U.S.C. § 1396a(k). See Consolidated Omnibus Budget Reconciliation Act of 1985, Pub.L. No. 99-272, $ 9506, 100 Stat. 82 (1985)(codified at 42 U.S8.C.1986a(k))(repealed 1998). Under 42 U.S.C. § 1396p(b)(2000), a state agency can recover benefits paid from either the recipient's estate or from the sale of property subject to a lien. See § 26-4-408.3(8), C.R.S. 1999; Department of Health Care Policy & Financing § 8.068.13, 10 Code Colo. Reg. 2505-10.

In order to secure any recovery, DHF must comply with the federal provisions regarding "liens, adjustments and recoveries of medical assistance correctly paid, transfers of assets, and treatment of certain trusts." 42 U.S.C. § 1896a(a)(18)(2000).

Under 42 U.S.C. § 1396p, only two exceptions exist to the general prohibition against imposing liens upon an individual's property prior to death. The first exception permits an agency to file a lien "pursuant to the judgment of a court on account of benefits incorrectly paid" for that individual. See 42 U.S.C. § 1896p(a)(1)(A)(emphasis supplied). The second exception authorizes state agencies to file liens on the real property of an individual:

[WJlith respect to whom the state determines, after notice and opportunity for a *970 hearing ...

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Oldham v. Pedrie
2015 COA 95 (Colorado Court of Appeals, 2015)
Clark v. Peters
547 F. App'x 892 (Tenth Circuit, 2013)
Peters v. Bryan (In Re Bryan)
469 B.R. 341 (D. Colorado, 2012)
Stell v. Colorado Department of Health Care Policy & Financing
78 P.3d 1142 (Colorado Court of Appeals, 2003)
In Re Conservatorship of Groves
109 S.W.3d 317 (Court of Appeals of Tennessee, 2003)

Cite This Page — Counsel Stack

Bluebook (online)
5 P.3d 967, 2000 Colo. J. C.A.R. 3674, 2000 Colo. App. LEXIS 1087, 2000 WL 796608, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alberico-v-health-management-systems-inc-coloctapp-2000.