Blue Ridge Nursing Home, Inc. v. Blue Cross

21 Va. Cir. 495, 1973 Va. Cir. LEXIS 30
CourtRichmond County Circuit Court
DecidedDecember 13, 1973
StatusPublished

This text of 21 Va. Cir. 495 (Blue Ridge Nursing Home, Inc. v. Blue Cross) is published on Counsel Stack Legal Research, covering Richmond County Circuit Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Blue Ridge Nursing Home, Inc. v. Blue Cross, 21 Va. Cir. 495, 1973 Va. Cir. LEXIS 30 (Va. Super. Ct. 1973).

Opinion

By JUDGE A. CHRISTIAN COMPTON

Enclosed you will find a copy of the order entered today which dismisses this action.

In the amended motion for judgment seeking judgment jointly and severally against the defendants, the plaintiff asserts that it is a Virginia corporation having its principal place of business in Stuart, Virginia, and that it carries on the business of a nursing home, being certified as an Intermediate Care Facility (ICF) by the Virginia State Health Department.

It alleges that it has accepted and cared for the welfare "clients" of the Patrick County, Henry County, and Martinsville City welfare boards who had qualified for "old age assistance" (OAA) or "aid to the permanently and totally disabled" (APTD) as defined in the Virginia Public Welfare and Assistance Law. Code, if 63.1-87 et seq.

Prior to January 1, 1971, it is alleged that the plaintiff's home was certified as an Extended Care Facility (EOF) under the Medicare Program and as a Skilled Nursing Facility under the Medicaid Program and "reimbursement monies" were "available from the fiscal intermediary" [496]*496for ECF patients and from the State Health Department for skilled Medicaid patients.

' It is further asserted that subsequent to January 1, 1971, when the plaintiff was certified as an ICF, about 87% of all payments made by the local boards aforesaid "on behalf of" their OAA and APTD "clients" to the plaintiff were reimbursed to these boards by the State Department of Welfare and Institutions (State Department).

The amended complaint states that "[i]n order to determine the amount of assistance which should be paid to authorized nursing homes on behalf of OAA and APTD patients pursuant to Title 63.1 of the Code of Virginia, it is alleged upon information and belief that the [State] Department, through the State Board entered into an agreement, contract, or arrangement with Blue Cross whereby Blue Cross, acting as agent on behalf of the [State] Department, the Division [of General Welfare], the local welfare boards, and local departments of social services or local departments of welfare and superintendents of such departments throughout the Commonwealth [including specifically the local defendants herein] . . . would calculate and determine the maximum rate at which nursing homes throughout the Commonwealth certified as ICFs, including specifically Blue Ridge, would be compensated for caring for OAA and APTD clients of the various local welfare boards.”

It is further alleged that upon the plaintiff's application for certification as an ICF "it became the duty of Blue Cross” pursuant to the terms of the aforesaid agreeinent to determine the maximum rate which the plaintiff would be entitled to receive for caring for the OAA and APTD patients of the local boards aforesaid. Following the submission in December of 1970 to Blue Cross of the required financial information, it is asserted that Blue Cross determined the rate aforesaid to be $513 per patient per month effective January 1, 1971, and that the plaintiff relied on this rate to its detriment "by planning the financial management of its home for the ensuing year."

Because the Patrick County Board in April of 1971 sought to transfer nineteen Of its "clients" to another nursing home, a dispute arose between the County and its patients, and Patrick County refused to continue payments on behalf of its nineteen patients during the time when [497]*497they successfully appealed the county ruling to the State Board. No payments were received by the plaintiff until November of 1971 when the State resumed payments and made them directly to the plaintiff, pursuant to Code, Section 63.1-123, but at the rate of $470.00 per patient per month. The plaintiff alleges that it continued to care for the nineteen patients at a level equal to that previously provided and did not discharge them during the period of the dispute.

It is alleged that such refusal to continue payments during the appeal process violated the rules of the State Department, the Division and the State Board of Welfare and Institutions (State Board).

The plaintiff asserts that during the appeal process aforesaid, the defendants "reevaluated” the rate and that it was advised on September 13, 1971, by the Director of the Division that "a considerable error" had been made in the computation of the rate by Blue Cross and that it would then be compensated at the $470.00 figure.

The plaintiff further alleges that when the State Board sustained the Patrick patients* appeals, it received compensation for caring for these persons from April, 1971, but at the lower rate of $470.00 per patient per month, as aforesaid. It contends that since October 1, 1971, it has received compensation for all OAA and APTD patients from the aforesaid local boards at the $470.00 rate.

It is further alleged that the plaintiff’s claim to the State Comptroller for compensation at the higher rate has been denied and it brings this suit seeking damages, costs, and attorney’s fees contending: that the defendants erroneously calculated the maximum rate; erroneously informed the plaintiff of the $513.00 rate upon which it justifiably relied; and that the proper rate is "in excess of" $470.00. Damages are claimed ”[a]s a result of the conduct of the defendants and their failure to perform their obligation ...."

Named as defendants are Blue Cross, the Comptroller, and, in their individual and official capacities, the Director of the State Department and the Division, the chairman and each member of the State Board, the Superintendents of the local departments and each member of the [498]*498local county boards and the City Council of Martinsville, and its City Manager. Everybody in sight has been sued.

The plaintiff argues that the facts alleged support a claim against each defendant both in contract (accepted offer for a unilateral contract and promissory estoppel) and in tort (misrepresentation).

1. The Martinsville Council and City Manager In Their Official and Individual Capacities.

No allegation is found in the amended motion for judgment asserting any identifiable claim against these defendants, officially or individually, so their demurrer is sustained.

2. The Other Defendants Sued In Their Individual Capacity.

With the exception of Blue Cross and The Comptroller, all of the remaining defendants have been sued both in their official and individual capacities. Their respective demurrers as they relate to the claim against each individually are severally sustained upon the ground that, considering the allegations of the amended motion for judgment as they must be on demurrer, no cause of action has been stated which would entitle the plaintiff to recover against these public officers individually upon either of the contract theories advanced or the tort theory asserted. In a nutshell, the facts alleged fail to support the argument advanced by the plaintiff.

Contract Liability

Each of the aforesaid defendants fall within the accepted definition of a public official, i.e. each occupies a position created by law with duties cast upon the incumbent which involve an exercise of some portion of sovereign power and in which the public is concerned, continuing in their nature, and not merely occasional or intermittent. 15 M.J., Public Officers, S 2, p. 62.

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Cite This Page — Counsel Stack

Bluebook (online)
21 Va. Cir. 495, 1973 Va. Cir. LEXIS 30, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blue-ridge-nursing-home-inc-v-blue-cross-vaccrichmondcty-1973.