Loading...
HomeMy WebLinkAbout07-4253IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANOR CARE HEALTH SERVICES -CARLISLE, Plaintiff, v. No. b7- ~SId53 CiYi ~ TP-r'M MICHAEL BARON, Defendant. CIVIL ACTION -LAW NOTICE TO DEFEND Pursuant to PA RCP No. 1018.1 YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 (717) 249-3166 (800) 990-9108 ORIGINAL EN LA CORTE DE ALEGATOS COMIJN DEL CONDADO DE CUMBERLAND, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANOR CARE HEALTH SERVICES -CARLISLE, : Plaintiff, v. No. MICHAEL BARON, Defendant. CIVIL ACTION -LAW AVISO PARA DEFENDER Conforme a PA RCP Nurn.1018.1 USTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se presentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veiente (20) dias despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objeccionee a, las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar accion Como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted pued perder dinero o propiedad u otros derechos importantes para usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANOR CARE HEALTH SERVICES -CARLISLE, Plaintiff, v. MICHAEL BARON, Defendant. COMPLAINT CIVIL ACTION -LAW AND NOW, COMES, Manor Healthcare Corp. d/b/a Manor Care Health Services -Carlisle, ("Plaintiff ManorCare"), by and through its attorneys, SCHUTJER BoGAR LLC, and files the within complaint against Michael Baron, ("Defendant Baron'), and in support thereof, provides as follows: 1. Plaintiff ManorCare is a Delaware corporation licensed to do business in the Commonwealth of Pennsylvania, with its principal offices located at 940 Walnut Bottom Road, Carlisle, Pennsylvania 17013. 2. Defendant Baron is an adult individual who currently resides at 228 North 3rd Street, Camp Hill, Pennsylvania 17011. 3. On or about July 25, 2006, Defendant Baron, by and through his son, Mark Baron, made application for admission to Plaintiff ManorCare's skilled nursing facility. 4. On or about May 25, 2006, Plaintiff ManorCare and Defendant Baron entered into a written Admission Agreement ("Agreement"), pursuant to which Plaintiff ManorCare agreed to provide Defendant Baron with skilled nursing care and services in exchange for his promise to pay a specific monetary fee for that care and services. A true and correct copy of the Agreement is attached as Exhibit "A." 5. Defendant Baron did not make payment for the skilled nursing care and services that Plaintiff ManorCare provided to him. 6. As a result of the nonpayment by Defendant Baron for the skilled nursing care and services provided to him, an outstanding balance in an excess of $23,000.00 is owed to Plaintiff ManorCare. COUNT I --BREACH OF CONTRACT 7. The allegations contained in Paragraphs 1 through 6 are incorporated by reference as if fully set forth at length. 8. Plaintiff ManorCare provided skilled nursing care and services to Defendant Baron in accordance with the terms and conditions of the Agreement attached as Exhibit "A." 9. Defendant Baron breached his contractual duties owed to Plaintiff ManorCare by failing to make payment for that skilled nursing care and services. 10. As a result of the aforementioned breach of Defendant Baron, Plaintiff ManorCare has incurred damages in an in excess of $23,000.00, plus costs, interest, and attorney's fees as provided in the Agreement attached as Exhibit "A." 2 WHEREFORE, Plaintiff ManorCare seeks judgment in its favor and against Defendant Baron in an in excess of $23,000.00, plus costs, interest, and attorney's fees as provided in the Agreement attached as Exhibit "A." Dated: ~ d~ Respectfully submitted, SCHUTJER BOGAR LLC By Chadwick O. Bogar Attorney I.D. No. 83755 (717) 909-5920 Maria G. Macus-Bryan Attorney LD. No, 90947 305 North Front Street, Suite 401 Harrisburg, PA 17111 (717) 909-8640 Attorneys for Plaintiff 3 Kx L`ate/'l'ime J7L-17-lUU7('I'UEj 1l:Ul Jul 17 2007 11:~i6RM HP LRSERJET FRX N. UIJl p.2 JUL-16-200i(MON) 13;18 PODS/005 VERiFICA?'ZON The undersigned hereby verifies that the statements of fact in the foregoing Corx~plaint an truL end correct to the best of my lcstowledge, information and belief. I understand that any fa]se statements therein are bvbject to the penalties contained in 18 Pa. C.S.A. § 4904, relating to unswortt falsification to authorities. Dated: Amy M h, Business ~Offzce Manager Martoz l-Icalthcaxe Corp. d/b/n Minor CarE Health Sacvices -Carlisle EXHIBIT "A° Nx Uate/'l'ime JUL-lU-000/l'I'Uh,l l5:ll Jul 10 2007 3:16PM HP LRSERJET FRX ADMISSION AGREEMENT I. Z. PARTIES, ADNIISSION DATE, AND DEPOSIT The following are parties to this Agreement: A. Center (VJe, Us, Our): Manor Care Health Services-Carlisle B. Patient (You, Your): Michael R. Baran C. Responsible Parry, if applicable (You, Your): Mark Baron Admission Date: 7.2.06 Deposit Amount: S 0 CENTER'S. RESPONSIBILTCIES We will: . uuq p.4 Pennsyltiania A. Provide You with a basic room, board, common facilities, housekeeping; laundered bed Einens, general nursing care, personal assessment, social services, and other services. B. Apply Your deposit, if any, to Your first one or two months of Your stay at Center. C. Refund any amounts owed to You within 30 days or within the time frame required by state law aver Your discharge or •transfer. 3. RESIDENT'S RIGHTS AND RESPONSIBILTTIES 3.1 You have the right to: A. Choose Your own personal physician as long as. the physician is properly licensed and complies wilt Our policies and procedures: B. Choose Your own pharmacy as long as the pharmacy complies with Our policies and procedures and operates in compliance with state and federal laws. In order for You.to receive.prescription drug coverage under Medicare Part D, the pharmacy must have a contract. with the Part D plan You select. 3.2 You will: A. Pay Us: l . the room and board rate for all days that You reside at the Center including the day of admission. lJniess you aze covered under Medicaid or an insurance plan that prohibits it, We may bill You for a late fee if You do not leave the Center before 12:00 p.m. on the day of Your discharge. The late fee will reflect any charges accrued by You while.in the Center after 12:00 p.m. on the day of Yow discharge. If We change the room and board rate, We will notify you in writing 30 days before the change, (Room and $oard Rates are listed in Attachment A). 2. all additional ancillary charges accrued by You while in the Center. (Ancillary Charges are described on Attachment B) 3. any co-insurance, deductibles or reimburseTnent You receive for non-covered services if You are eligible for any insurance or governmental program including Medicare, Medicaid, or Veteran's Administration. 4. Any additional or denied charges that are not covered by Your insurance company's benefit•or third party payer 5. within 30 days of the date on the bill.. If We hire a collectior. agency or attorney to co}lest payment an Your account, You will pay for these collection costs. uate/rune Jul 10 2007 3:17PM LUU/lfUt1 17: LL HP LRSERJET FRX . uu7 p.5 B. Pay other providers, including Your attending physician, directly for care they provide to You. C. Notify Us of Your coverago under any insurance plans or government programs. D. Notify Us is writing within 5 days if Your coverage under any insurance plans or government programs changes while You are at the Center. E. Assign Us the right:to bill and receive money directly from Your insurance, or govern-nent payor. You authorize Center and any holder ofinedical or other information to release such information to the Centers for Medicare and Medicaid Services and its agents and to third party payors any information needed to determine Your beneftts and Our right to receive payment. F. Pay for any damage You cause to any person or property on Center grounds. G. Abide by our policies and procedures. 4. RESPONSIBLE PARTY'S RESPONSIBILITIES You will: A. Have legal access to the Patient's income or resources and deliver any documents supporting such authority to the Center. B. Pay for all charges that Patient incurs while at the Center front the Patient's income or resources. C_ Notify Us immediately and in writing if.the Patient's financial resources aze depleted. D. Secure Medicaid in a timely and proper manner. E. Cooperate with Us by providing information about the Patient's finances. F. Transfer and accept the Patient when it is medically appropriate to discharge the Patient from the Center. G. Abide by Our policies and procedures. H. Not misappropriate the Patient's income or resources or use them for the benefit of someone other than the Patient. I. Be personally liable for the payment of all charges if You fail to fulfill Your other responsibilities under this Agreement. 5. CONSENT You consent to allow Us to: A. Use and disclose your health information for purposes of treatment, payment, or health care operations. B. Treat You to maintain Your well-being. C. Photograph you for identification purposes. 6. TERM AND TERMINA'T'ION 6.1 Term This Agreement begins on the day You are admitted to the Center and ends on the day You aze~ dischaged from the Center unless you are readmitted within 15 days of Your discharge date. If You aze re-admitted. within 15 days of being discharged from the Center, this Agreement will continue in effect as of the date of Vour re-admission. Nx Uate/'time JUL-IU-ZUU'/('I'U1;) Ih:LL N.Utib . Jul 10 2007 3:17PM HP LRSERJET FRX p,g 6.2 Termination A. By You: You may terminate this Agreement: 1. immediately if you leave the Center because of emergency; or 2. by providing ?days written notice of Your intent to leave the Center. . B. By Us: bVe may terminate this Agreement and discharge You from the Center by notifying You in writing. Where legally required, We will notify you at least 30 days prior to Your transfer or discharge. In. cases where the safety or health of You or other individuals in the Center maybe endangered, or if other legal reasons exist, we will notify You as_soon as practicable before transferor discharge. we can terminate the Agreement for any of the following reasons: 1. Your needs cannot be met in the Center; 2. Your health has sufficiently improved so that You no longer need Our services; 3. The.safety of other individuals in the Center is endangered; 4. The health of other individuals in the Center is endangered; 5. After appropriate notice, You have failed to pay for your stay at the Center; or 6. We cease to operate the Center. 7. ACKNOWLEDGMENTS . You acknowledge that You have received the following attachmerrts: A. Room and Board Rate -Attachment A B. AnciDary. Charges -Attachment B C. Notice of Information Practices and Receipt of Notice of Information .Practices -Attachments C-t and C-2 D. Resident's Personal Trust Fund Agreement -Attachment D E. SNF Medicare Determination Form -Attachment E F. Medicare Secondary Payor Questionnaire -Attachment F G. .Summary of Limited Treatment Policy-Attachment G H. Medicare and Medicaid Information 1. Patient Information Handbook 3. Center Supplement K. Resident Rights By signing the Admission Agreement, You acknowledge that you have been given and have read this Agreement in its entirety, anc' all its attachments. You agree that all infaimation submitted as part of Your admission to the Center is true and correct. You acknowledge that the Center relies on the accuracy of al[ information submitted by You or on Your behalf in determining whether to admit You Eo the Center. By signing below, the parties agree to the terms of this Admission Agreement: ~(~ -' atient r-'`.J Date Center Representative Date Nx Uate/'l'ime JUL-IU-ZUU7('1'UEI 15:ZL . ,Jul 10 2007 3:17PM HP LRSERJET FRX If applicable: R sponsib .~ Date ~c 1 ~z > ~ l.s - 7y~~r Responsible Party's Telephone Nnmbe~• r. uu r p.7 4 ~ n {yo, # '~ ,,,p L r-~ (~ (~J r- °°, ~ ~' r- . *~ ~~-.~~ .,r .,~ :.., ;_J t '~'? C.~ a ~3 r~ :.~ T l 'n i" ~,t --~7 '-G O v IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANOR CARE HEALTH SERVICES -CARLISLE, Plaintiff, v. MICHAEL BARON, Defendant. No. 07-4253 Civil Term CIVIL ACTION -LAW PRAECIPE TO WITHDRAW TO THE PROTHONOTARY: Kindly withdraw, without prejudice, our Complaint filed in the above captioned matter on July 19, 2007. Dated: 6 -l D~ Respectfully submitted, SCHUTJER BOGAR LLC By: ~'~- Chadwick O. Bogar Attorney I.D. No. 83755 (717) 909-5920 Maria G. Macus-Bryan Attorney I.D. No. 90947 (717) 909-8640 305 North Front Street; Suite 401 Harrisburg, PA 17101 Attorneys for the Plaintiff ORIGINAL CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Praecipe to Withdraw Complaint was served first-class, United States mail, postage prepaid, upon the following: Michael Baron 228 North 23rd Street Camp Hill, PA 17011 Dated: ~ `~ ~~ By: ~- William Keslar, Paralegal C? ~ ~ ~ ~ r+r c) ..-- 3'~ "`.' f.e~ ..~5 vC'z _ 1 +'~ ~ ~~ ~ r ~ ~ SHERIFF'S RETURN - NOT FOUND CASE NO: 2007-04253 P ~OMMONTWEALTH OF PENNSYLVANIA • COUNTY OF CUMBERLAND MANOR HEALTHCARE CORP ET AL VS BARON MICHAEL R. Thomas Kline ,Sheriff or Deputy Sheriff, who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named DEFENDANT BARON MICHAEL but was unable to locate Him in his bailiwick. He therefore returns the COMPLAINT & NOTICE the within named DEFENDANT BARON MICHAEL 228 NORTH 23RD STREET NOT FOUND as to CAMP HILL, PA 17011 PER NEIGHBOR, DEFENDANT WAS ONLY HOME 3 DAYS LAST YEAR. HE IS IN VA HOSPITAL AT UNKNOWN LOCATION. Sheriff ' s Costs : So answers ,rte,--~' ~ - ~ ~° Docketing 18.00 ~ ___ Service 14.4 0 - °~~F ._~,.~--- ~ --~-^"''~!,~'`" Not Found 5.00 ~ R. Thomas ine Surcharge 10.00 Sheriff of Cumberland County .00 s J I'1~C'~ ~ v 4 7. 4 0 SCHUTJER & BOGAR 08/01/2007 Sworn and Subscribed to before me this day of , A.D.