Fisher v. Smith (In Re Medico Associates, Inc.)

23 B.R. 307
CourtUnited States Bankruptcy Court, D. Massachusetts
DecidedSeptember 21, 1982
Docket19-10465
StatusPublished
Cited by5 cases

This text of 23 B.R. 307 (Fisher v. Smith (In Re Medico Associates, Inc.)) is published on Counsel Stack Legal Research, covering United States Bankruptcy Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fisher v. Smith (In Re Medico Associates, Inc.), 23 B.R. 307 (Mass. 1982).

Opinion

THOMAS W. LAWLESS, Chief Judge.

MEMORANDUM AND ORDER

Before the Court are several performance and accounting issues relating to the measure of damages sustained by the above-named plaintiffs, a Debtor and its Receivers, respectively, in arrangement proceedings under Chapter XI of the Bankruptcy Act commenced on May 26, 1976 (hereinafter, collectively “Medico”). In the Court’s Memorandum and Order partially granting plaintiffs’ motion for summary judgment, I found (1) that a fixed price contract requiring New York City (the “City”) to pay $7.50 per patient per day over and above the basic Connecticut Medicaid rate was in existence and embodied in an April 13, 1973 letter (the “Contract”) from the City to Medico; (2) that the fixed price Contract was not in violation of applicable Federal and State Medicaid/Medicare law; and (3) that Medico and its affiliate Connecticut nursing homes 1 had substantially performed in accordance with its obligations under that Contract.

While the Order granting partial summary judgment decided three specific aspects of this litigation, several issues relating to Medico’s performance under the Contract and the- appropriate measure of damages were not decided therein because they presented factual disputes which were incapable of resolution when ruling upon a motion for summary judgment. Accordingly, the Court held several days of trial to resolve these issues. Having heard the testimony presented at trial and having reviewed the pleadings, legal memoranda, affidavits and voluminous exhibits submitted by the parties, I make the following findings of fact and conclusions of law.

I PERFORMANCE ISSUES

The defendants question whether Medico’s performance under the Contract entitles the plaintiffs to any reimbursement *309 for the patient care provided by Medico to the New York patients or, alternatively, whether there should be an offset from any damages awarded herein for alleged defects in Medico’s contractual performance. In the Court’s Order partially granting plaintiffs’ motion for summary judgment, I found that, except for certain specific performance issues, there was no genuine issue as to any material fact regarding the fact that Medico’s performance was in accordance with the Contract.

Before discussing these performance issues, I first consider what law to apply. In the Court’s partial summary judgment Order, at 12, in keeping with the ruling of Klaxon Co. v. Stentor Electric Mfg. Co., 313 U.S. 487, 61 S.Ct. 1020, 85 L.Ed. 1477 (1940), I applied the Massachusetts conflicts decisions and determined that New York, as the place of the making of the Contract, governed the nature, validity and interpretation of this Contract and New York law will govern issues relating to Medico’s performance under this agreement.

Treating the reserved performance issues in turn, I find as follows:

A MEDICARE PART A BENEFITS

Medicare, title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq, is a national health insurance program for the aged and disabled. Under Medicare certain expense monies are paid to patients who are enrolled in the Medicaid program and the physicians who render services to these Medicaid patients. Medicare Part A benefits, § 1395c-1395i, provides federal insurance for basic in-patient hospital services and post-hospital services at home or in nursing homes for the patients’ room and board and other items within that category for the first 100 days of their institutionalization. New York City asserts that Medico failed to reimburse and report to the City certain Medicare Part A benefits and Social Security benefits Medico was to have collected on behalf of the New York City Medicaid patients in the Connecticut Homes. The defendant further argues that Medico’s failure to reimburse and file reports with the City with respect to these benefits constituted a material. breach of Medico’s obligation under the Contract. Medico disputes these allegations and asserts that at all times they have been in compliance with the agreement.

The April 3, 1973 Contract provides that: Medico agrees that it will apply immediately for Medicare A benefits and will not bill us for such benefits until a determination has been made. In the event that the individual is eligible for Medicare A benefits during the first 100 days, Medico will bill us only for the difference between $26.75 and the Medicare benefits. If there is other income available such as Social Security benefits, Medico will also deduct from the $26.75 after passing along $24.50 to the patient for his personal needs.

After considering the evidence, I am convinced that Medico has properly applied for and credited to the defendants the Medicare Part A benefits and Social Security benefits received by the patients. The defendants, by affidavits or otherwise, do not seriously challenge that Medico has credited the City with the monies received under this program. 2 Medico did not bill the defendants for services eligible to be covered by the Part A program, but rather billed the defendants therefore at the end of the 100 day period only upon a determination that the patient was not eligible for Part A reimbursement.

The defendants also contend that Medico was deficient in filing reports with the City and the State regarding the Social Security and Part A benefits. As noted in the Court’s Order granting partial summary judgment, at 17, the parties are in accord that the Contract between Medico and the City is subject to the provisions of governing Federal Medicaid Law, 42 U.S.C. § 1396 *310 et seq., and New York Medicaid Law, N.Y. S.S.L. § 363 et seq. Medicaid law requires that a state plan for medical assistance must provide for agreements with every person or institution providing services under the plan. These agreements must contain a provision requiring the institution to “furnish the State agency or the Secretary with such information, regarding any payments claimed by such person or institution for providing services under the State plan, as the State agency or the Secretary may from time to time request; ...” (emphasis added). 42 U.S.C. § 1396a(a)(27).

The City of New York alleges that Medico’s failure to regularly and systematically report the receipt of the Medicaid Part A and Social Security benefits impaired the City’s ability to pay benefits under the subject provider agreements. Medico disputes these allegations and asserts that at all times it has been in conformance with the Contract and applicable Medicaid law.

I find that Medico’s treatment and reporting of the Medicare Part A and Social Security benefits was in conformance with the Contract and applicable law and was recognized and accepted by the City.

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Bluebook (online)
23 B.R. 307, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fisher-v-smith-in-re-medico-associates-inc-mab-1982.