Recent Elder Law Cases Related To Medicaid


Two court cases from other states demonstrate principles of elder law:

Suit Against Lawyer

Massachusetts attorney Joseph Roy was hired by two nursing home residents to secure Medicaid coverage. The nursing home sent billing information and other letters to Roy, and contacted his office several times to check on the status of the applications.

When Medicaid benefits did not materialize, the nursing home finally filed suit against Roy himself. The home alleged that Roy had intentionally misrepresented the status of the Medicaid applications, that he had failed to file them on time and that he had filled out the forms inaccurately. The result, according to the nursing home, was that Medicaid benefits were delayed and that the services provided to the residents were not compensated.

Roy successfully argued that the nursing home had not retained him and that he did not owe the facility any duty of competent representation. The court did, however, permit the suit to proceed on the theory that Roy had actively misrepresented his actions, thereby arguably defrauding the nursing home. New Webster Nursing Home v. Joseph H. Roy, Jr., Esq., Mass. Super. Ct., May 30, 1995.

Claim Against State

In the second case, a group of Medicaid recipients sued the state of Alabama, alleging that the state failed to provide transportation to medical appointments. According to the suit, the lack of transportation forced recipients to skip treatment and their conditions worsened.

The claimants pointed to federal regulations requiring such transportation; Alabama officials argued that the regulations exceeded the Congressional mandate in Medicaid legislation. The Federal Court Judge agreed with the claimants. The Court found that the language of the regulations is consistent with the legislation, and that the requirement is clearly mandatory. Harris v. James, U.S. District Court of Alabama, April 26, 1995.

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