Mount Sinai Hospital v. Brinn

73 Misc. 2d 1, 341 N.Y.S.2d 208, 1973 N.Y. Misc. LEXIS 2247
CourtCivil Court of the City of New York
DecidedFebruary 5, 1973
StatusPublished
Cited by11 cases

This text of 73 Misc. 2d 1 (Mount Sinai Hospital v. Brinn) is published on Counsel Stack Legal Research, covering Civil Court of the City of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mount Sinai Hospital v. Brinn, 73 Misc. 2d 1, 341 N.Y.S.2d 208, 1973 N.Y. Misc. LEXIS 2247 (N.Y. Super. Ct. 1973).

Opinion

Harry T. Nusbaum, J.

This action was instituted by the plaintiff, Mount Sinai Hospital, to collect charges for the treatment and hospitalization of the defendant and third-party plaintiff, Ronald Brinn. Mr. Brinn in turn has impleaded the Commissioner of the Department of Social Services by the service of a verified third-party complaint which alleges that the third-party [2]*2plaintiff was eligible for medical assistance under the provisions of title 11 of article 5 of the Social Services Law as a “ medically indigent ” person and the claim, if valid, is due and payable from the Department of Social Services.

The case presents a classic example of the web of laws, rules, regulations and public assistance directives and requirements that have been enacted to preserve and protect the moneys set aside to aid the needy which, by their volume and complexity, frustrate the very purpose for which the public assistance laws were enacted by our Congress and State Legislature. It has for some time been a matter of public concern and scandal that persons intent upon defrauding the city, State and Federal Governments out of these precious funds have little trouble in so doing, while many of our improverished, needy and deserving are often faced with an impenetrable wall of red tape which would appall and frighten any honest applicant for Medieaid relief.

As an example of the foregoing, I set forth some of the statutory citations submitted by the attorneys for the Department of Social Services to buttress its denial of liability for the claim asserted. Beginning with title XIX of the Social Security Act of 1965, effective as of January 1, 1966, the fountainhead of the program to provide medical assistance for the indigent, we have, the implementing statutes contained in the several volumes of the Public Welfare Law (U. S. Code, tit. 42), the Federal Handbook of Public Assistance, the Social Services Law of the State of New York, the Rules of the State Board of Social Welfare, and the Regulations of the State Department of Social Services. These, coupled with strict bureaucratic interpretations of the applicable statutes, rules and regulations and the forms required to be submitted for qualification and eligibility, constitute a challenge which the most literate of lay persons would fail to meet. Needless to say, welfare recipients who automatically qualify for medical assistance and dishonest applicants whose answers to the questionnaire bear little relationship to the truth have no such problem.

The defendant and third-party plaintiff Ronald Brinn was a college student, attending the City University when, on June 2, 1970, he entered Mount Sinai Hospital for surgery. He was discharged from the hospital on June 17, 1970. The hospital bill for services rendered for this short stay was $2,578.95. At that time his only source of income was $20 a week which he received from the seek program. Out of this sum he paid $15 a week for both room and board to an aunt with whom he resided. [3]*3On July 21, 1970, he filed an application for medical assistance, which was rejected on the grounds of incomplete information provided by the applicant. He thereupon filed another application which, on November 30,1970, was also rejected for the same reason. Yet another application was filed and finally, on June 8, 1971, Mr. Brinn received a notification from the Bureau of Medical Assistance of the Department of Social Services which certified that he had been found eligible for Medicaid ” and was entitled to all available benefits”. He notified Mount ■ Sinai Hospital of his eligibility, but the hospital never billed the Department of Social Services for the charges incurred by Mr. Brinn.

Resistance to the payment of the bill by the Department of Social Services is now based upon the following:

(a) More than 12 months have elapsed since the services were rendered (Rules of the New York State Board of Social Welfare, § 105, subd. [d]).

(b) The failure of the vendor, Mount Sinai Hospital, to bill the Department of Social Services (Federal Handbook of Public Assistance, § 5810; Social Services Law, § 367-a).

The refusal of the Department of Social Services to pay the claim appears also to be based upon the fact that the letter of eligibility, which was mailed to Mr. Brinn, indicated that the effective date of Mr. Brian’s eligibility was July 1, 1970. In view of the fact that the services which were rendered to Mr. Brinn were rendered between June 2, 1970, and June 17, 1970, and the application was specifically for the payment of hospitalization services which the Department of Social Services knew had taken place just prior to the eligibility date set forth on the certificate, the issuance of the certificate did not solve the problem. The only explanation for setting this effective date appears to be that from the application filed by Mr. Brinn the board determined that he was only eligible after July 1, 1970 because prior to that time, by an error in calculation or perhaps a mistake made by the applicant in filling out the application, it appeared that he was earning $1,820 per annum, which sum (prior to June 30, 1970) would make him ineligible to receive Medicaid assistance. The law with respect to eligibility was changed on July 1, 1970 and, as a result of such change, persons earning up to $1,910 per annum were eligible for Medicaid.

The alleged error which led to this mix-up arose out of Mr. Brian’s listing of the $15 a week which he paid to his aunt in the wrong place on the application form, and the person processing the application assumed that Mr. Brinn’s income con[4]*4sisted of the $20 a week which he earned from the seek program plus the additional $15 a week he paid to his aunt. This, however, was not the fact and the plaintiff has stated under oath, and I credit his statement, that at the time he made the application for Medicaid, his total income was $20 a week or $1,040 per annum. It is interesting to note that a witness from the Department of Social Services, Bureau of Medical Assistance, testified that if the application had been properly filled out so as to indicate that Mr. Brinn in fact only received $1,040 annually, he would, without any question, have been entitled to Medicaid for the period in question.

At this point, therefore, my view of the problem is that although the defendant and third-party plaintiff was admittedly qualified and eligible for Medicaid by reason of his income, he nevertheless was refused such Medicaid because of his inability to understand or properly fill out the complicated forms required. This, coupled with the failure of the Department of Social Services to heed the mandate contained in section 363 of the Social Services Law ‘ ‘ to facilitate the application for, and the provision of such medical assistance ’ ’ and the failure of the Mount Sinai Hospital to bill the Department of Social Services for the charges incurred by Mr. Brinn, even though notified of his eligibility for Medicaid, now are put forth as reasons for not paying for the medical services rendered to him. Once again, therefore, form has taken precedence over substance and the defendant and third-party plaintiff herein is being deprived of a right which was granted to him by the Congress of the United States and our State Legislature.

In 1966, the State Legislature enacted into law “ Title 11 — Medical Assistance For Needy Persons ”, as part of the Social Welfare Law (now known as the Social Services Law).

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Bluebook (online)
73 Misc. 2d 1, 341 N.Y.S.2d 208, 1973 N.Y. Misc. LEXIS 2247, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mount-sinai-hospital-v-brinn-nycivct-1973.