Glengariff Corp. v. Snook

122 Misc. 2d 784, 471 N.Y.S.2d 973, 1984 N.Y. Misc. LEXIS 2893
CourtNew York Supreme Court
DecidedJanuary 4, 1984
StatusPublished
Cited by7 cases

This text of 122 Misc. 2d 784 (Glengariff Corp. v. Snook) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Glengariff Corp. v. Snook, 122 Misc. 2d 784, 471 N.Y.S.2d 973, 1984 N.Y. Misc. LEXIS 2893 (N.Y. Super. Ct. 1984).

Opinion

OPINION OF THE COURT

Beatrice S. Burstein, J.

This case, apparently one of first impression, involves the scope of a Federal statute and regulation and a counterpart State regulation, each of which essentially requires that payments received from Medicaid by a provider of services shall be accepted as payment in full.

Plaintiff seeks summary judgment, pursuant to CPLR 3212, claiming there are no issues of fact, or, in the alternative, for an order dismissing defendants’ affirmative defenses, pursuant to CPLR 3211 (subd [b]), on the ground they have no merit. Defendants cross-move for an order, pursuant to CPLR 3025 (subd [b]), granting them leave to amend their answer so as to assert the affirmative defense of payment, and based thereon, they seek an order dismissing plaintiff’s complaint, pursuant to CPLR 3211 (subd [a], par 5). Leave to amend is granted. The court thereby deems the answer amended so as to include a seventh affirmative defense of payment, as set forth in the [785]*785proposed amended answer contained in the cross-moving papers. The court now considers whether either summary judgment or the dismissal defendants seek will lie.

The following facts are uncontroverted. Plaintiff operates a private licensed nursing home and, at all relevant times, was a participant in what is commonly known as the Medicaid program.

Defendant Margaret Snook is a patient in plaintiff’s nursing home. Prior to her admittance, plaintiff’s representative met with her son, defendant Robert Snook (hereinafter defendant). The representative avers, on personal knowledge, that defendant said he would prefer to pay more to have his mother in a private room rather than a semiprivate room. At that time, defendant Margaret Snook was not receiving any public assistance. Three days later, on July 10, 1982, Margaret Snook entered the home as a private patient. On that date, defendant signed an agreement as “Sponsor”, which provided, inter alia, that:

“1. The Glengariff Corporation hereby admits the Patient to the Facility. In consideration, the Patient and Sponsor agree to pay The Glengariff Corporation its basic charge for the basic facility services furnished (itemized in the following paragraph 2) at the current daily basic rate of $95.60 for a private room, or at such increased basic rate that shall comply with paragraph 6 below * * *

“Patient and Sponsor acknowledge and agree that the Glengariff Corporation is not obligated to accept Medicaid payments in lieu of the private payments from the Patient and Sponsor required hereunder unless and until (a) the Patient shall have been a patient in the Facility for a period of at least 18 months and (b) the Patient and Sponsor shall have paid in full all sums due The Glengariff Corporation hereunder from the Patient and Sponsor for all periods prior to the first actual receipt of such Medicaid payments and shall have performed in full all of the obligations under this agreement on their part to be performed during such periods. The Glengariff Corporation will credit against the sums due The Glengariff Corporation hereunder from the Patient and Sponsor any reimbursements actually received from Medicare for Facility services and items furnished by The Glengariff Corporation to the Patient”. [786]*786Defendant paid for the period July 10, 1982 through September 30, 1982. Then he ceased making payments. His security deposit was applied by plaintiff and therefore plaintiff was actually paid by defendant through November 24, 1982.

On October 8, 1982, defendant made application for Medicaid on his mother’s behalf. Initially this was refused, apparently on the ground that she was not in need of medical assistance because defendant had agreed to pay for her care. He appealed. Following a fair hearing, the denial was found improper, and the Nassau County Department of Social Services (DSS) was directed to provide assistance retroactive to November 24, 1982, the date when defendant’s security payments were exhausted.

The decision after fair hearing states that as defendant ceased making payments on the patient’s behalf, and as he cannot be required to do so pursuant to the Social Services Law, his funds cannot be considered an available resource to the patient. The decision further states that DSS can explore the feasibility of requiring defendant Margaret Snook to pursue “a third-party cause of action” against defendant on the basis that the agreement between plaintiff and defendant herein is a potentially available resource under “section 360.4(a)” presumably 18 NYCRR 360.4 (a). This regulation requires as a condition of eligibility that a Medicaid recipient pursue any potential resource not currently available. Apparently no action was ever taken in that regard by DSS. The specific question before this court now is whether defendant is still obligated on the agreement either for the difference between the sums the plaintiff received from Medicaid for the care of Margaret Snook and the amount defendant agreed to pay for her care for 18 months, or the entire amount (in which case plaintiff would reimburse Medicaid for its share).

Medicaid is a joint Federal-State grant-in-aid program, which was established pursuant to section 1396 et seq. of title 42 of the United States Code, commonly known as the Federal Security Act. (Matter of Westhampton Nursing Home v Whalen, 67 AD2d 1017, revd on other grounds 60 NY2d 711.) Through this co-operative venture, the Federal Government supplies funds to State programs run in accor[787]*787dance with Federal requirements. (Aitchison v Berger, 404 F Supp 1137,1141.) A privately owned and operated nursing home which provides services to persons eligible to receive Medicaid (such as plaintiff’s) is reimbursed according to rates established by the New York State Department of Health pursuant to the procedure set forth in section 2807 of the Public Health Law. (Hurlbut v Whalen, 58 AD2d 311.) In order to receive the benefits of the Medicaid program, including reimbursements, plaintiff was required to sign a “Provider Agreement” with New York State (Matter of Westhampton Nursing Home v Whalen, 67 AD2d 1017, revd on other grounds 60 NY2d 711, supra) and, of course, generally is bound by various relevant statutes and regulations.

In opposition to plaintiff’s motion for summary judgment, defendants rely upon certain of those statutes and regulations. They claim the agreement is void, as a matter of law, on the grounds it is contrary to Federal and State law and public policy, and that plaintiff’s receipt of payment from Medicaid constitutes full payment, beyond which it is not entitled to recover. One such statute is section 2805-f of the Public Health Law, which, in subdivision 4, essentially classifies the knowing and willful act of charging more for services provided a Medicaid recipient than is received from Medicaid as a class E felony. However, that subdivision did not become effective until the thirtieth day after July 22,1982. (L 1982, ch 716, § 1.) This was more than a month after plaintiff and defendant entered into the agreement at issue. Therefore, the statute does not specifically govern plaintiff’s acts. (Goldfarb v Goldfarb, 86 AD2d 459; Kinney v Kinney, 48 AD2d 1002; City of Troy Unit of Rensselaer County Ch. of Civ. Serv. Employees Assn. v City of Troy, 36 AD2d 145, 147, affd 30 NY2d 549.)

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Bluebook (online)
122 Misc. 2d 784, 471 N.Y.S.2d 973, 1984 N.Y. Misc. LEXIS 2893, Counsel Stack Legal Research, https://law.counselstack.com/opinion/glengariff-corp-v-snook-nysupct-1984.