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MERCY HOSPITAL v. COMMONWEALTH PENNSYLVANIA (05/08/85)

decided: May 8, 1985.

MERCY HOSPITAL, PETITIONER
v.
COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, RESPONDENT



Appeal from the Order of the Department of Public Welfare in case of Appeal of: Mercy Hospital, 746 Jefferson Street, Scranton, Pa. 18501 -- Re: Margaret Connell, dated August 9, 1983.

COUNSEL

Joseph A. O'Brien, Oliver, Price & Rhodes, for petitioner.

Bruce G. Baron, Assistant Counsel, with him, John Kane, Assistant Counsel, for respondent.

Judges MacPhail, Barry and Palladino, sitting as a panel of three. Opinion by Judge MacPhail. Judge Williams, Jr., did not participate in the decision in this case. Dissenting Opinion by Judge Barry.

Author: Macphail

[ 89 Pa. Commw. Page 193]

Mercy Hospital (Mercy) appeals here from an order of the Pennsylvania Department of Welfare's Office of Hearings and Appeals (Office) which denied Mercy reimbursement for care it rendered to a patient eligible for medical assistance.

Mercy, an acute care facility, sought reimbursement from the Department of Public Welfare (DPW) for care it rendered to patient Margaret Connell (Connell). Mercy's claim was for the period between

[ 89 Pa. Commw. Page 194]

February 21, 1983 and March 16, 1983, when Connell was no longer in need of acute care, but due to an administrative delay in approving her transfer to another facility, she remained at Mercy.

After an initial administrative denial of Mercy's request for reimbursement, Mercy appealed. A hearing officer recommended that the appeal be sustained, reasoning that Mercy made every reasonable effort to promptly transfer Connell and continued to provide medically necessary services until the transfer could be accomplished.*fn1 The Office rejected the recommendation and denied reimbursement. The instant appeal followed.

Our scope of review of a DPW denial of reimbursement is limited to a determination of whether constitutional rights have been violated, whether there was an error of law or whether any necessary findings of fact made by DPW are not supported by substantial evidence. Montgomery County Geriatric & Rehabilitation Center v. Department of Public Welfare, 75 Pa. Commonwealth Ct. 248, 462 A.2d 325 (1983). In this appeal, Mercy contends that DPW is estopped to deny reimbursement because the delay in the transfer was caused by DPW.*fn2

[ 89 Pa. Commw. Page 195]

The DPW relies upon regulations from its Medical Assistance Manual, Sections 9421.74(q) and 9421.74(r), ...


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