In 2014 the case of Mary Slepicka was contested wherein it was claimed in the lawsuit that Holy Family Villa Nursing Facility incorrectly billed her during her stay. The key issue in the appeal was venue. The court in 2014 ruled that she was wrong to file her case in Springfield, Ill., instead of Chicago. The unanimous opinion of the Illinois Supreme Court, authored by Justice Charles E. Freeman, said the venue mistake was not fatal to earlier administrative and trial court rulings, which determined she was correctly evicted from the nursing home for failing to pay living expenses.
The Supreme Court justices ordered the case back to the Illinois Appellate Court. The Illinois Appellate Court for the 4th District determined there was not enough evidence to reverse the initial decisions.
In the lawsuit, Slepicka claimed she was qualified for a lower Medicaid rate. Her contract with the nursing home in 2011 listed her as paying a higher out-of-pocket expense. In addition, she was given a room that wasn’t certified for Medicaid coverage.
That contract had provisions stating that the facility would accept public funds in lieu of private money, but it could still charge Medicaid recipients at regular rates for items and services not covered under the plan. It also said involuntary discharge was a possible consequence of late payments or non-payments of the nursing home’s monthly fees.
Employees at the nursing home testified that they knew she was eventually looking to move to the Medicaid plan, but the nursing home kept her in a private-pay room until March 5, 2012 because there was a waiting list for Medicaid-certified rooms. The employees testified that Mary’s list of assets indicated she could continue to afford private payments.
What the employees didn’t immediately know was that a chunk of her money was placed in a special trust designed to qualify her for lower Medicaid rates.
As a result of these multiple categories of fees and payments, the nursing home claimed she owed nearly $16,000 by May 2012. She claimed the nursing home facility took advantage of her by keeping her in the non-certified room for months and billing her a private-pay rate of $232 per day instead of the Medicaid rate of $137.16 a day.
In the decision, it was stated that there was no proof that the nursing home acted in bad faith. In addition, it was stated that the situation was ambiguous enough that the Department of Health and Human Services’ administrative ruling was not against the manifest weight of the evidence.
“Given all these ambiguities, we do not find it to be ‘clearly evident’ from the administrative record that . . . defendant should be precluded from charging (Slepicka) private-pay rates.” “Nor do we find it to be ‘clearly evident’ that defendant breached the duty of good faith and fair dealing by refraining from assigning plaintiff to a Medicaid-certified bed sooner than March 5, 2012.” The Illinois Supreme Court is expected to decide whether to take up the case later in January 2016.
Slepicka v. State of Illinois, No. 119969 (Illinois Supreme Court).
Kreisman Law Offices has been handling nursing home abuse cases, nursing home negligence cases and medical malpractice cases for individuals and families who have been injured or killed by the negligence of a medical provider for more than 40 years, in and around Chicago, Cook County and its surrounding areas, including Romeoville, Bolingbrook, Grayslake, Lake Forest, Lake Bluff, Wilmette, Winnetka, Glencoe, Kenilworth, Evanston, Skokie, Chicago (Rogers Park, Wicker Park, Bucktown, Lawndale, Hegewisch, East Side), Calumet City and Berkeley, Ill.
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