In Re Madeline Marie Nursing Homes. State of Ohio

694 F.2d 433, 1982 U.S. App. LEXIS 23754
CourtCourt of Appeals for the Sixth Circuit
DecidedNovember 29, 1982
Docket80-3549
StatusPublished
Cited by61 cases

This text of 694 F.2d 433 (In Re Madeline Marie Nursing Homes. State of Ohio) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In Re Madeline Marie Nursing Homes. State of Ohio, 694 F.2d 433, 1982 U.S. App. LEXIS 23754 (6th Cir. 1982).

Opinion

694 F.2d 433

In re MADELINE MARIE NURSING HOMES.
STATE OF OHIO, Plaintiff-Appellant,
v.
Phil C. COLLINS, d/b/a Pleasant Ridge Nursing Home, Tepper
Nursing Home, St. Lawrence Nursing Home and
Grandville Manor Nursing Home, Defendant-Appellee.

No. 80-3549.

United States Court of Appeals,
Sixth Circuit.

Argued Oct. 20, 1981.
Decided Nov. 29, 1982.

William J. Brown, Atty. Gen. of Ohio, Thomas W. Hess, Asst. Atty. Gen., Columbus, Ohio, for plaintiff-appellant.

James P. Edmiston, Bauer, Morelli & Heyd, Cincinnati, Ohio, for defendant-appellee.

Before ENGEL and KENNEDY, Circuit Judges, and BROWN,* Senior Circuit Judge.

ENGEL, Circuit Judge.

This appeal raises difficult issues concerning the complex state and federal statutory and regulatory schemes involved in the delivery of Medicaid services to eligible patients. While the original problems were of an accounting nature, they have been rendered far more difficult by the complexity and uncertainty of the rules which are intended to resolve them and by the further circumstance that they arose in the course of bankruptcy proceedings.

In July, 1978, appellee Phil Collins commenced proceedings in the Bankruptcy Court for the Southern District of Ohio, Western Division, for an arrangement under Chapter XI of the Bankruptcy Act of 1898, as amended, 11 U.S.C. 701 et seq. (1976) (repealed 1979), as sole owner of four nursing homes in Ohio and as owner in partnership with his wife of two other homes.

Shortly after the proceedings were filed, the State of Ohio filed two proofs of claim with the bankruptcy court against the bankruptcy estate totaling $280,387.88, covering 1973 to 1975. During the trial, the state amended its proofs of claim and reduced the amount to $239,934.60, representing alleged overpayments made by Ohio to Collins as a provider under the federal-state Medicaid program between January 1, 1973 and December 31, 1977. Collins, as debtor in possession, filed his objection to the allowance of the claims and also a counterclaim seeking $519,290.32 from the state based upon failure of the Ohio Department of Public Welfare ("ODPW") (the Ohio state agency administering Medicaid)1 to make allowance for owner's compensation, depreciation and return of owner's equity, and the improper use of a prospective reimbursement formula for 1976 and 1977. After a five day trial, the bankruptcy judge disallowed Ohio's proof of claim but refused to enter a judgment against the state on Collins' counterclaim. The district court affirmed, and this appeal by Ohio followed.

I.

To obtain reimbursement for services performed and expenses incurred for Medicaid patients, Collins filed cost reports with ODPW for the years involved in this appeal, and these reports were later audited by ODPW.

The state's original claim was based upon a November, 1977 audit of Collins' books, records and cost reports. During the bankruptcy trial, however, this audit was largely discredited. Instead, reliance was placed on a second audit that had occurred in the summer of 1978. Both audits showed that Collins had filed false cost reports with inflated figures. In January and February of 1978, Ohio began procedures to terminate Collins' status as a Medicaid provider. Ohio then attempted in July 1978 to recover the claimed overpayments through a garnishment proceeding brought in state court. Following this, Collins sought the refuge of Chapter XI proceedings on July 21, 1978.

Meanwhile, the federal government commenced criminal proceedings against Collins, resulting in his conviction of seven counts of mail fraud in violation of 18 U.S.C. Sec. 1341 (1976). His conviction and sentence to four months imprisonment and a $7,000 fine were affirmed by this court in United States v. Collins, 596 F.2d 166 (6th Cir.1979) (per curiam). Each count of the indictment related to alleged fraudulent and inflated cost reports submitted by mail to Ohio with respect to the defendant's seven nursing homes.2 Collins had filed the cost reports in connection with his efforts to obtain Medicaid reimbursement during 1973. As will be discussed, Ohio's resulting and justifiable distrust of Collins has been a major block to any sensible resolution of the disputes which arose later.

Although the record clearly shows the frustration of the bankruptcy judge resulting from the state's poorly organized presentation of its claim, a modicum of agreement was reached between the parties and the court concerning the accounting for 1973, 1974 and 1975. At least tacitly it was agreed that the second ODPW audit was substantially correct, as a matter of bookkeeping. Although only the 1973 cost reports had been the subject of criminal proceedings, it was evident that similarly inflated costs had been submitted for the years 1974 and 1975. The second audit essentially determined what the correct figures were and recomputed the amount of reimbursement to which Collins had been entitled. In its amended proof of claim, Ohio asserted a claim for the difference between what was actually paid to Collins and the lesser amount that should have been paid according to figures from the 1978 audit.

Differences, however, remained between Ohio and Collins. For 1973-75, Collins contended that ODPW had improperly denied him owner's compensation, return on owner's equity, and depreciation.3 Ohio responded that Collins had not complied with the requirements to recover owner's compensation and that he had received the other payments to the extent required by state and federal law. With regard to 1976, Ohio applied a prospective reimbursement system to the 1978 audit, with the result that Collins owed the state over $50,000.00. Collins, on the other hand, contended that a retrospective system, as had been used for 1973-75, should be applied to the audit figures. Under Collins' approach, the state owed him over $150,000.00.

After trial in the bankruptcy court, the bankruptcy judge entered an order which disallowed Ohio's proofs of claim for 1973-76 because the amount which Collins was owed exceeded any amount which was claimed by the State of Ohio. In re: Madeline Marie Nursing Homes, Nos. B-1-78- 1029/1030, mem. dec. and order (Bankr.S.D.Ohio July 17, 1979). The bankruptcy judge made the following factual findings: Collins owed Ohio $23,554.72 due to overpayments caused by inflated cost reports in 1973-75; Ohio owed Collins $141,824.25 under the retrospective reimbursement in 1976; and Ohio owed Collins $40,000.00 per year for 1973-75 for owner's compensation. Because this more than eliminated Ohio's claim, the judge made no finding as to owner's equity or depreciation. At the same time, he declined to render any affirmative judgment against Ohio upon the concession of the debtor that the bankruptcy court was without the power to do so under the doctrine of sovereign immunity as embodied in the Eleventh Amendment.4

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694 F.2d 433, 1982 U.S. App. LEXIS 23754, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-madeline-marie-nursing-homes-state-of-ohio-ca6-1982.