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MANSION NURSING AND CONVALESCENT HOME v. COMMONWEALTH PENNSYLVANIA (03/25/86)

decided: March 25, 1986.

MANSION NURSING AND CONVALESCENT HOME, INC., 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: Mansion Nursing and Convalescent Home, Inc., File Nos. 23-83-308 and 23-83-309.

COUNSEL

Daniel L. Sullivan, Shearer, Mette & Woodside, with him, Jeffrey Apfelbaum, Apfelbaum & Apfelbaum, for petitioner.

Bruce G. Baron, Assistant Counsel, with him, John Kane and Jules S. Henshell, for respondent.

Judges Craig and Palladino, and Senior Judge Kalish, sitting as a panel of three. Opinion by Judge Craig.

Author: Craig

[ 96 Pa. Commw. Page 139]

Mansion Nursing and Convalescent Home, Inc. appeals from an order of the Office of Hearings and Appeals granting the Department of Public Welfare's (DPW) motions to dismiss. We reverse.

Mansion, a private nursing facility providing skilled nursing and intermediate care to medical assistance

[ 96 Pa. Commw. Page 140]

    patients, was a participant in the Medical Assistance Program. As a participant, Mansion received medical assistance payments from DPW, for allowable costs for the services it provided to its patients. In order to receive the allowable costs, Mansion was required to file with DPW annual cost reports by June 30 of each year, the end of Mansion's fiscal year, so that DPW could conduct an audit to determine the amount of Mansion's allowable costs.

For the 1981-82 fiscal year, Mansion requested an extension to file its cost report, which DPW granted until December 31, 1982. Mansion did not file that cost report until May 6, 1983.

In addition, Mansion sold its nursing home on January 1, 1983, which obligated Mansion to file with DPW a final cost report within thirty days after the effective date of the transfer. Mansion did not file that final cost report until May 6, 1983.

In September 1983, DPW conducted a "limited review" of Mansion's annual and final cost reports for the fiscal periods ending June 30, 1982, and December 31, 1982. DPW concluded that Mansion was eligible to receive medical assistant payments; however, because Mansion had failed to file its cost reports on time, DPW determined that Mansion's allowable costs for both fiscal periods were zero. Further, DPW assessed an overpayment against Mansion for the interim payments DPW had made to Mansion, $378,373.89 for the fiscal period ending June 30, 1982, and $173,651.36 for the fiscal period ending December 31, 1982, based on its determinations that Mansion had zero allowable costs.

The only issue raised on appeal by Mansion is whether DPW had the authority to determine Mansion's allowable costs to be zero as a sanction for the late ...


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