HomeMy WebLinkAbout08-2146f
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
MANOR HEALTHCARE CORP. d/b/a
MANORCARE HEALTH SERVICES -
CARLISLE,
Plaintiff,
V. No. 0$- QN Oivit Tern
RAYMOND DELL,
Defendant. CIVIL ACTION - EQUITY
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.
Lawyer Referral Services
Cumberland County Bar Association
32 South Bedford Street
Carlisle, PA 17013
Telephone: (717) 249-3166
(800) 990-9108
ORIGINAL
EN LA CORTE DE ALEGATOS COMUN DEL
CONDADO DE CUMBERLAND, PENNSYLVANIA
MANOR HEALTHCARE CORP. d/b/a
MANORCARE HEALTH SERVICES -
CARLISLE,
Plaintiff,
V. No.
RAYMOND DELL,
Defendant. CIVIL ACTION - EQUITY
AVISO PARA DEFENDER
Conforme a PA RCP Num. 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. i.
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.
Lawyer Referral Services
Cumberland County Bar Association
32 South Bedford Street
Carlisle, PA 17013
Telefono: (717) 249-3166
(800) 990-9108
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
MANOR HEALTHCARE CORP. d/b/a
MANORCARE HEALTH SERVICES -
CARLISLE,
Plaintiff,
V. No. 6 P - &;d
yG 7-e,,
RAYMOND DELL,
Defendant. CIVIL ACTION - EQUITY
COMPLAINT
AND NOW, COMES, Plaintiff, Manor Healthcare Corp. d/b/a ManorCare
Health Services - Carlisle, ("Plaintiff ManorCare"), by and through its attorneys,
SCHUTJER BOGAR LLC, and files the within Complaint against Defendant, Raymond Dell
("Defendant Dell"), and in support thereof, provides as follows:
1. Plaintiff ManorCare, a corporation licensed to do business in the
Commonwealth of Pennsylvania, is a residential and skilled nursing care provider with
its principal offices located at 940 Walnut Bottom Road, Carlisle, Pennsylvania 17015.
2. Defendant Dell is an adult individual who currently resides at 301 North
Second Street, Lemoyne, PA 17043.
3. On or about October 26, 2007, Defendant Dell made application for the
admission of his mother, Arlene Dell ("mother"), to Plaintiff ManorCare's skilled
nursing facility.
4. On or about October 26, 2007, Plaintiff ManorCare and Defendant Dell
entered into a written Admission Agreement ("Agreement"), pursuant to which
Plaintiff ManorCare agreed to provide Defendant Dell's mother with skilled nursing
care and services in exchange for his promise to pay a specific monetary fee from his
mother's assets and, in the event that she were to become insolvent, to secure Medical
Assistance benefits in a timely and proper manner. A true and correct copy of the
Agreement is attached hereto as Exhibit "A."
5. After Defendant Dell's mother became a resident of Plaintiff ManorCare's
skilled nursing facility, she apparently became insolvent. As a result, pursuant to the
Agreement, Plaintiff ManorCare notified Defendant Dell that he needed to apply for
Medical Assistance benefits on behalf of his mother, and an application for Medical
Assistance benefits was subsequently filed.
6. Because Defendant Dell did not provide the necessary documentation to
the Cumberland County Assistance Office to secure Medical Assistance benefits on
behalf of his mother, the Cumberland County Assistance Office denied the application
on January 28, 2008. A true and correct copy of the denial is attached hereto as Exhibit
„B
7. Subsequently, an appeal of the Cumberland County Assistance Office's
denial of the above-referenced application for Medical Assistance benefits was filed,
and that appeal is currently pending before the Bureau of Hearings and Appeals of the
Department of Public Welfare of the Commonwealth of Pennsylvania.
2
8. If Defendant Dell fails to produce the information requested by the
Cumberland County Assistance Office prior to or at the time of the hearing scheduled
on the aforementioned appeal, the appeal will fail, and any further appeal to the
Commonwealth Court would be without merit.
COUNTI
BREACH OF CONTRACT/ SPECIFIC PERFORMANCE
9. The allegations contained in Paragraphs 1 through 8 are incorporated
herein.
10. Defendant Dell breached his Agreement with Plaintiff ManorCare when
he failed to secure Medical Assistance benefits for his mother, and Defendant Dell
continues to breach his Agreement with Plaintiff ManorCare by failing to provide those
documents needed by the Cumberland County Assistance Office to determine his
mother's eligibility for Medical Assistance benefits.
11. Defendant Dell's breach of his Agreement with Plaintiff ManorCare has
irreparably harmed and continues to cause Plaintiff ManorCare irreparable harm.
12. Only a decree of specific performance will adequately protect the interests
of Plaintiff ManorCare and provide it with the benefits and/or protections promised
under the Agreement.
3
WHEREFORE, Plaintiff ManorCare seeks a decree from this Honorable Court
which orders specific performance of the Agreement between the parties.
Respectfully submitted,
Dated
SCHUTJER BOGAR LLC
B
Bradley A. Schutjer
Attorney I.D. No. 75954
(717) 909-5921
Brandon S. Williams
Attorney I.D. No. 200713
(717) 909-5922
417 Walnut St, 4th Floor
Harrisburg, PA 17101
Attorneys for Plaintiff
4
VERTFICAT70
I?1
The undersigned hereby verifies that the statements of fact in the foregoing
Complaint are true and correct to the best of my knowledge, information and belief, T
understand that any false statements therein are subject to the penalties contained in 19
Pa. C.S.A. § 4904, relating to unswom [a]-sification to authorities.
Dated;
/2VId- M2.d?
Amy Mars , Business Office Manager
Manor Healthcare Corp. d/b/a
ManorCare Health Services - Carlisle
EXHIBIT "A"
Date/Time MAN-11-20U81'I'UE! 11:37
Mar 11 2008 11:33AM CRRLISE MAIN
\I....
ADMISSION AGREEMENT
1. PARTIES, ADMISSION DATE, AND DEPOSIT
The following are parties to this Agreement:
A. Center (We, Us, Our): ManorCare Carlisle
B. Patient (You, Your): Arlene E Dell
C. Responsible Party, if applicable (You, Your): Raymond Dell
Admission Date: 10/26/2007 Deposit Amount: $ 0
2. CENTER'S RESPONSIBILITIES
We will:
N. UU3
p.3
Pennsylvania
A. Provide You with a basic room, board, common facilities, housekeeping, laundered bed linens,
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
after Your discharge or transfer.
3. RESIDENT'S RIGHTS AND RESPONSIBILITIES
3.1 You have the right to:
A. Choose Your own personal physician as long as the physician is properly licensed and complies
with 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:
1. the room and board rate for all days that You reside at the Center including the day of
admission. Unless you are 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 Your discharge. If We change the room and board rate, We will
notify you in writing 30 days before the change. (Room and Board 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 reimbursement 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. upon receipt of the bill. If We hire a collection agency or attorney to collect payment on Your
account, You will pay for these collection costs.
7172490647
7172490647
Nx Date/Time MAK-I I-2UU8 ('1'UE) 11:37
M"ar 11 2008 11:34RM CRRLISE MAIN
7172490647 P.U04
7172490647 p.4
B, Pay other providers, including Your attending physician, directly for care they provide to You.
C. Notify Us of Your coverage under any insurance plans or government programs"
D. Notify Us in 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 government payor.
You authorize Center and any holder of medical 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 benefits 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 from the Patient's income or resources.
C. Notify Us immediately and in writing if the Patient's financial resources are 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.
1. 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 TERMINATION
6,1 Term
This Agreement begins on the day You are admitted to the Center and ends on the day You are discharged
from the Center unless you are readmitted within 15 days of Your discharge date. If You are re-admitted
within 15 days of being discharged from the Center, this Agreement will continue in effect as of the date of
Your re-admission.
Date/Time
M'ar 11 20013 11:34RM CRRLISE MRIN 7172490647 p.5
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 7 days written notice of Your intent to leave the Center.
B. By Us:
We 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 may be endangered, or if
other legal reasons exist, we will notify You as soon as practicable before transfer or 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.
ACKNOWLEDGMENTS
You acknowledge that You have received the following attachments:
A. Room and Board Rate - Attachment A
B. Ancillary Charges - Attachment 3
C. Notice of Information Practices and Receipt of Notice of Information Practices - Attachments C-1
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
J. 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, and all its attachments. You agree that all information submitted as part of Your admission to the Center
is true and correct. You acknowledge that the Center relies on the accuracy of all information submitted by You or
on Your behalf in determining whether to admit You to the Center.
Hx hate/'l'ime MAK-11-2UWl'Uh) 11:37
Mar 11 2008 11:34RM CRRLISE MRIN
Date
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Date
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Date
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Responsible Parry's Telephone Number
717249U647 P.UUb
7172490647 p.6
By signing below, the parties agree to the terms of this Admission Agreement:
Patient
/;?, J??
Center Representative
If licable:
E
Mar 31 2008 9:15AM CRRLISE MAIN
CUMBERLAND CAD MEDICAID
P.O. BOX 599 DISCONTINUE
33 WESTMINSTER DRIVE NOTICE
CARLISLE PA 17013-0599
CAO RETURN ADDRESS CSLD 0033
ARLENE E DELL
MANORCARE CARLISLE
940 WALNUT BOTTOM ROAD
CARLISLE PA 17815
7172490647
Notice ID: Re19407R
21 8104878 0 PAN 00
WORKER. K PEARSON
TELEPHONE (7171 240-2708
MAIL DATE: 0111512068
NOT. 842OPT: OrYPE: D
AP Tw W NCr UNWAWAW OUR OSISION aR HAVE ANY
QUESTIONS, PLEASE 4WALT YOUR N= = 11MEDIATFLY.
You have been determined inelipfble for Medicaid including services in a Long-
Term Care facility. We requested verification of certain information in order
that we could determine eligibility. As of 0111412808, we have not received
the following: MA51; Options Assessment; social security card; proof of date
of birth; verification of all gross income; cash value of Met Life policies;
Personal Care Account balance; verification of all resources transferred or gi
yen away: vehicle reaistration: 10126197 cash value of all life insurance:
deed to cemetary; deed to all property. verification of money received if sold
10126/07 cash value of Net Life policy: Droof of shelter and utility expenses
income tax returns andlor 1099 forms.
REGULATIONS:55 PA Code 125.84 (e)
If you disagree with our decision, you have the right to appeal. See attached form
for a complete exoalnation of your right to appeal and to a fair caring. If you are MIDPENN LEGAL S
currently receiving benefits and your oral request for a hearing is received in the 401-405 LOUTHER
County Assistance Office or your written request is postmarked or received on or CARLISLE
before 81/28!2008 your assistance will continue pending the hearing decision,
except when the change is due to State or Federal law.
ARLENE E DELL
MANORCARE CARLISLE
940 WALNUT 807TOM ROAD
CARLISLE PA 17615
CUMBERLAND CAD
P.O. BOX 599
33 WESTMINSTER DRIVE
CARLISLE PA 17013.6599
Notice Ip: 80104878
21 81048713. 0 PAN 00
WORKER-
APPEAL
K PEARSON
01/28/2008
p.3
PAGE 1 OF 1
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CASE NO.: 08-2146 Civil Term
AFFIDAVIT OF SERVICE
Manor Healthcare Corp. d/b/a
ManorCare Health
Services-Carlisle
VS.
Raymond Dell
Commonwealth of Pennsylvania
County of Dauphin as.
I, John Shinkowsky, a competent adult, being duly sworn according to law, depose and say that at 8:14 PM on
05/03/2008, I served Raymond Dell at 301 North Second Street, Lemoyne, PA 17043 in the manner described
below:
® Defendant(s) personally served.
? Adult family member with whom said Defendant(s) reside(s).
Relationship is
? Adult in charge of Defendant(s) residence who refused to give name and/or relationship.
? Manager/Clerk of place of lodging in which Defendant(s) reside(s).
? Agent or person in charge of Defendant's office or usual place of business.
? an officer of said Defendant's company.
? Other:
a true and correct copy of Notice to Defend, Complaint, Verification issued in the above captioned matter.
Description:
Sex: Male - Age: 50 - Skin: White - Hair: Balding - Height: 5' 09" Weight: 170
Sworn to and subscribed before me on thi.%- Jan Shinkowsky
d200T S?linkowsky Ines g tions
316 Fawn Ridge r
Harrisburg, PA 1 10
(800) 276-0202
NOTARY Atty F
ile#: - Our File# 3656
Law Firm: Schutjer Bogar LLC
Address: 417 Walnut Street, 4th Floor, Harrisburg, PA, 17102
Telephone: (717) 909-5925
dk'YirlBMYwklll 8f t+EMllt?'I.VAPIIA OTARIAL SEAL
LAURA A. NARASEWlCN, Notary public
Susquehanna Twp., Dauphin County
My Commission Expires Aug..30, 2008
ORIGINAL
o +*a
W
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
MANOR HEALTHCARE CORP. d/b/a
MANORCARE HEALTH SERVICES -
CARLISLE,
Plaintiff,
V.
No. 2008-2146 Civil Term
RAYMOND DELL,
Defendant. CIVIL ACTION - EQUITY
PRAECIPE TO WITHDRAW, DISCONTINUE AND END
To the Prothonotary:
Kindly mark the above-captioned action withdrawn, discontinued and
ended.
Respectfully submitted,
Dated: O By:
Attorney I.D. No. 75954
(717) 909-5921
Brandon Williams
Attorney I.D. No. 200713
(717) 909-5922
417 Walnut Street, 4th Floor
Harrisburg, PA 17101
Fax No.: (717) 909-5925
Attorneys for Plaintiff
ORIGNAL
ScHu'rjm BOGAR LLC
CERTIFICATE OF SERVICE
I hereby certify that a true and correct copy of the foregoing Praecipe to
Withdraw, Discontinue and End was served via first-class, United States mail,
postage prepaid, upon the following:
Taylor P. Andrew, Esquire
ANDREWS & JOHNSON
78 West Pomfret Street
Carlisle, PA 17013
Counsel for Defendant
Date: 69 o a
William Keslar, Paralegal
P
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