Representing Clients Who Are Patients
Monday, May 18, 2009
Outline
DEFENSE OF INAPPROPRIATE CLAIMS BY VENDORS/PROVIDERS OF MEDICAL SERVICES AGAINST THIRD PARTIES FOR UNPAID EXPENSES
The typical scenario involves claims by hospitals, nursing homes or the like against spouses, children or other relatives for medical expenses provided to a third person. The vendor/providers often rely upon written guarantees of payment buried within numerous documents at the time of admission or within lengthy admission agreements. The family member admitting the patient, who is often unconscious, incompetent or under emergency circumstances, do not realize that personal liability for the medical expenses of the patient are being sought to be imposed upon such third parties. A further basis of liability could involve claims of fraudulent conveyances (Debtor and Creditor Law Article 10) arising from even innocent estate planning (e.g. transfer of deed or gifts of assets) before or after the services were rendered to the patient/transferor.
Various contract defenses such as missing requisite elements of a contract, fraud in the inducement or misrepresentation, Statutes of Frauds writing requirements (General Obligations Law §5-701(2)) various statutory defenses under the Social Services Law, §§363, 363-a, et sec. and defenses under the applicable case law may be raised in addition to other defenses under CPLR Rule 3211(a) such as lacking jurisdiction, Statutes of Limitations, payment and release, failure to state a cause of action (e.g. adequate consideration for the gift or no intent to defraud), etc.
Under the doctrine established by the Third Department in Amsterdam Memorial Hospital v. Cintron, 52A.D.2d, 384 N.Y.S.2d 225 (Third Dept. 1976), the court held that as a matter of law, the statutory intent is that the hospital (medical provider) must look to the appropriate Social Services agency for payment and may no longer simply rely upon a husband’s (relative’s) duty to provide necessaries or a guarantee of payment executed from an individual upon admission of an eligible person, and further noted previous cases in which it was held that the vendor of medical services may not seek to directly hold Medicaid qualified recipients liable for unpaid bills of a third party.
There are a number of reported and other unreported decisions wherein courts noted they are loath of attempts by medical providers and their counsels to seek to improperly shift the burden of satisfying obligations for medical payment that lie with Social Service agencies on the recipient or their relatives. See also:
Society of the New York Hospital v. Mogensen, 319 N.Y.S.2d 258 (N.Y.C. Civ. Ct. 1971), Aff’d. & Mod. 373 N.Y.S.2d 722 (1st Dept. 1972);
Brooklyn Hospital v. Criss, 349 N.Y.S.2d 488 (N.Y.C. Civ. Ct. 1973);
Knickerbocker Hospital v. Downing, 317 N.Y.S.2d 688 (N.Y.C. Civ. Ct. 1970);
Carabello v. Santiago, 425 N.Y.S.2d 754 (Sup. Ct. Kings Co. 1980);
Howe Avenue Nursing Home, Inc. v. Nafus, 379 N.Y.S.2d 338, Aff’d. 387 N.Y.S.2d 272 (2d Dept. 1976);
Mt. Siani Hospital v. Sugarman, 347 N.Y.S.2d 807 (N.Y.C. Civ. Ct. 1973);
N.Y.C. Health and Hospitals Corp. v. Gorman, 448 N.Y.S.2d 623 (Sup. Ct., N.Y. Co. 1982); and
N.Y.C. Health and Hospitals Corp. v. Jones, 457 N.Y.S.2d 355, (N.Y.C. Civ. Ct. 1982).
