Navigating Medicare and other benefits can be difficult for seniors. This was no more apparent than in a recent SCLS appellate victory over National Healthcare /Mauldin, LLC (NHC) where the S.C. Court of Appeals was asked to reverse a trial court decision against our client Wade Thompson, an elderly, disabled veteran from Anderson County.
In a victory for our client in National Healthcare LLC vs. Wade Thompson, https://www.sccourts.org/opinions//unpublishedopinions/HTMLFiles/COA/2019-UP-378.pdf SCLS Attorney Susan Ingles[1] and PAI Attorney Sharon Ward[2] teamed up to obtain a reversal of the trial court decision that granted a judgment of $8,869.32 to NHC against Thompson. The S.C. Court of Appeals reversed the trial court’s original judgment that was based on quantum meruit, an equitable doctrine to allow recovery for unjust enrichment. “A party may be unjustly enriched when it has and retains benefits or money which in justice and equity belong to another.”
In reversing the trial court, the Court of Appeals held that NHC is estopped from seeking recovery from Thompson because it acted with “unclean hands”[3] by admitting Thompson to its care under the assumption of Medicare coverage and then failing to notify Thompson of its own corporate email response stating no benefit days were available to Thompson.
NHC failed to notify Thompson that his stay at its Mauldin, SC facility would not be covered by Medicare. The healthcare facility had obtained initial telephone verification of Medicare coverage at the time of admission, but the follow up written verification NHC received less than 24 hours later confirmed the stay would not be covered. Thompson had already exhausted his benefit days under Medicare rules. As a result, Thompson’s subsequent 6-week stay was not paid for by Medicare as NHC personnel assured Thompson when he was admitted. After NHC did not receive the $8,669.32 from Medicare that Thompson unwittingly incurred for six weeks, they filed the debt collection lawsuit against Thompson and his daughter. The trial court dismissed Thompson’s daughter from the lawsuit and that decision was not appealed by NHC.
In the appeal, NHC argued that Thompson was unjustly enriched by the 6-week stay it provided that Medicare did not pay for. The Court of Appeals held NHC’s failure to tell Thompson of the lack of coverage as soon as it received the written verification constituted unclean hands and held he was only liable for a $630 charge he had already paid.
Ingles and Ward successfully argued
that NHC’s failure to notify Thompson that his stay would not be covered was
fatal to its claim that he should pay for the stay out of his own pocket. The S.C. Court of Appeals agreed.
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[1] A 15 year veteran at SCLS, Ingles is a Senior Staff Attorney and head of the Consumer Unit.
[2] The Private Attorney Involvement (PAI) is funded by SCLS’ grant from the Legal Services Corporation. The collaborative program exists to encourage the involvement of private attorneys like Ward, who previously served as a staff attorney at the S.C. Court of Appeals, in the delivery of legal assistance to eligible legal aid clients
[3] The doctrine of unclean hands precludes a Plaintiff (here NHC) from recovering in equity if it acted unfairly in a matter that is the subject of the litigation to the prejudice of the defendant (here Thompson).
