Valley Memorial Homes v. Hrabik (In Re Hrabik)

330 B.R. 765, 2005 Bankr. LEXIS 1708, 2005 WL 2160071
CourtUnited States Bankruptcy Court, D. North Dakota
DecidedJuly 28, 2005
Docket19-30193
StatusPublished
Cited by10 cases

This text of 330 B.R. 765 (Valley Memorial Homes v. Hrabik (In Re Hrabik)) is published on Counsel Stack Legal Research, covering United States Bankruptcy Court, D. North Dakota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Valley Memorial Homes v. Hrabik (In Re Hrabik), 330 B.R. 765, 2005 Bankr. LEXIS 1708, 2005 WL 2160071 (N.D. 2005).

Opinion

MEMORANDUM AND ORDER

WILLIAM A. HILL, Bankruptcy Judge.

By Complaint filed February 25, 2005, Valley Memorial Homes initiated this adversary proceeding seeking a determination that Debtor Wayne Arthur Hrabik’s outstanding obligation to it for his mother’s care in the amount of $3,941.75 is nondischargeable pursuant to 11 U.S.C. § 523(a)(2), (4) and (6). The Debtor filed an Answer and Counterclaim on March 25, 2005, denying the allegations.

I. Findings of Fact

Wayne Hrabik’s mother, Marcella A. Hrabik, executed a durable power of attorney, dated October 9, 2001, designating Wayne Hrabik as her attorney in fact and stating that he was to handle all of her financial matters. It provided that he was to pay all of her “just debts and expenses” and to do whatever was necessary and proper in the management of her affairs. The power of attorney was to be used for her benefit and exercised only in a fiduciary capacity.

A. Valley Memorial Homes

Marcella Hrabik lived independently and managed her own affairs until she was hospitalized because of a fall in March 2002. She was admitted to Valley Memorial Homes’ long-term care facility on April 9, 2002.

On April 25, 2002, Valley Memorial Homes sent a letter to Wayne Hrabik stating that it had made a determination that the services furnished to her after April 25, 2002, would not qualify for payment by Medicare. It further stated:

This decision has not been made by Medicare. It represents our judgement that the services you needed no longer *769 meet Medicare payment requirements. A bill will be sent to Medicare for the services you received up to and including April 25, 2002. Normally, the bill submitted to Medicare does not include services provided after this date. If you want to appeal this decision, you must request that the bill being submitted to Medicare include the services we determined to be non-covered. Medicare will notify you of its determination. If you disagree with that determination, you may file an appeal.
Under provision of the Medicare law, you do not have to pay for non-covered services determined to be custodial care or not reasonable or necessary unless you had reason to know the services were non-covered. You are considered to know that these services were non-covered effective with the date of this notice.
Please check one of the boxes on the next page to indicate whether or not you want your bill submitted to Medicare and sign the notice to verify receipt.

Wayne Hrabik signed the attached sheet verifying he received notice of non-coverage of services under Medicare on April 30, 2002. He also marked the option that states:

I do want my bill for services I continue to receive to be submitted to the intermediary for Medicare decision. You will be informed when the bill is submitted.
If you do not receive a formal Notice of Medicare Determination within 90 days of this request, you should contact:
BLUE CROSS BLUE SHIELD of North Dakota
4510 13th Avenue Southwest
Fargo, ND 58121-0001
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NOTE: Beginning October 1st, 1989, you are not required to pay for services which could be covered by Medicare until a Medicare decision has been made.

An administrative officer signed the attached sheet verifying that Wayne Hrabik was advised of the non-coverage of services under Medicare by telephone on April 25, 2002.

Wayne Hrabik sent a letter to Valley Memorial Homes on April 30, 2002, stating that he felt Medicare coverage should be continued based on his examination of Marcella Hrabik’s medical records:

It is my opinion that since Altru [Hospital] recommended continued therapy and supervision at an outside facility, that Marcella continue to be covered by Medicare coverage until such time that a licensed doctor can re-evaluate her condition. I do not feel, after reading the reports from Altru, that Marcella’s medical condition has stabilized and do not feel that coverage should be discontinued.

A billing statement sent to Wayne Hra-bik dated May 1, 2002, contains a handwritten note made by Diane Lundgren, the Valley Memorial Homes employee who files Medicare claims and handles collections, stating: ‘You are not obligated to pay any nursing services until we get a notice from Medicare on your appeal. Pay for personal charges only at this time for 20.00. Thank you”. A billing statement sent to Wayne Hrabik dated June 1, 2002, had the same handwritten note on it.

Marcella Hrabik left Valley Memorial Homes and moved to St. Anne’s Guest Home on June 20, 2002.

Valley Memorial Homes sent a billing statement dated July 1, 2002, to Wayne Hrabik with a note handwritten by Lund-gren stating, “I have sent a final claim to Medicare to see if they will pay. Demand *770 bill for April was paid by Medicare. Pay personal charges for now. Thank You.” The note on the August 1, 2002, billing statement says, “You owe 67.00 for haircare from last month’s billing. We never received the payment. Balance of 7,883.50 has been filed to Medicare to see if they will approve payment. Pay personal charges only at this time. Thank you.” The September 1, 2002, billing statement says: “Medicare appeals were denied. Total amount is due at this time. Thank you.” The total amount on that statement is $7,883.50.

Lundgren testified that even though she used the word “appeal” on the statements, it was actually a demand claim to see if Medicare would pay for the services. She sent two demand claims to Medicare. After Valley Memorial Homes makes a demand billing, Medicare sends a notice of its determination to both Valley Memorial Homes and the representative of the resident. If Medicare denies coverage, a resident may appeal the Medicare determination on her own. However, Valley Memorial Homes has the right to collect from the resident once Medicare denies coverage even if the resident appeals. If the appeal is successful, Valley Memorial Homes refunds the payments made by the resident.

The October 1, 2002, billing statement contains a note saying, “Please advise as to when payment will be made. Medicare denied the appeal.” The November 1, 2002, billing statement did not have a handwritten note by Lundgren, but still showed $7,883.50 due.

Wayne Hrabik testified that he began to question the appeal process at this point. He wrote a letter to Valley Memorial Homes dated November 12, 2002 stating: “No payment or interest will be paid on this account at this time, payment pending decision of the appeal.” He testified he wanted an explanation for the charges to determine whether they were appropriate, but he was denied access to Marcella Hra-bik’s health records by his brother, Ron Hrabik, who held a power of attorney for Marcella Hrabik’s health care.

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Bluebook (online)
330 B.R. 765, 2005 Bankr. LEXIS 1708, 2005 WL 2160071, Counsel Stack Legal Research, https://law.counselstack.com/opinion/valley-memorial-homes-v-hrabik-in-re-hrabik-ndb-2005.