Failure to Follow Procedure • Failure to Mitigate
Presbyterian Homes, Inc. v. Bair, PICS Case No. 16-1334 (C.P. Lycoming Oct. 14, 2016) Gray, J. (5 pages).
Nursing care patient signed a standard agreement on entry, and nursing home commenced application for Medicaid but failed to use reasonable care and diligence to correct any omissions on the application, resulting in its denial. Home also failed to use reasonable care in billing patient’s supplemental insurance company and Medicare for any amounts prior to billing patient directly. Home filed a claim for breach of contract for failing to pay for services, but the court found it failed to follow standard procedure, failed to use reasonable care in obtaining payment, and failed to take steps to mitigate the costs. Home failed to establish that it was entitled to payment from patient, and the court found in favor of patient.
