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Upcoming SCOTUS ruling could impact Medicaid

On Behalf of | Oct 10, 2022 | Health Law Attorneys, Medicare Reimbursements

Medicare and Medicaid are the two primary government health programs that benefit many Texans at some time in their life. Medicare typically provides for elderly individuals until they need nursing home residency, but falls short when funding is needed for nursing home coverage. Beneficiaries are then transferred to Medicaid when they can qualify because it provides nursing facility coverage. This means that nursing home companies also rake in the profits in the process. And now one company is asking the U.S. Supreme Court to exempt them from financial liability for substandard treatment.

Understanding the plaintiff

Health & Hospital is the company requesting exemption from duty of care requirements established in the Federal Nursing Home Reform Act. This federal health care law allows patients to sue for substandard or abusive nursing home care. The health care company is owned by Marion County of Indiana, operating 78 facilities in state. They are attempting to use their technical status as a government-owned company to claim exemption from liability in nursing home abuse claims.

Issues with the lawsuit

One of the major issues in the lawsuit is who decided to file for exemption. The company has a Board of Directors that is appointed through multiple government agencies, but the board did not even vote on the lawsuit. The board deferred legal decisions to company management, and in particular the CEO who has much to gain from the exemption ruling. Health & Hospital has raked in over $1.8 billion in Medicaid funds over the past two decades per federal healthcare law for service providers. The decision to sue was also made without public input.

While this ruling is being sought by a government-owned business in the state of Indiana, it will have a massive national domino impact. A ruling in Health & Hospital’s favor means that other nursing home companies with even minimal government ownership will be exempt from liability as well for nursing home abuse.

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