Hall v. Dawson

• Decision Date: 14 June 1968
• Citation: 429 S.W.2d 366
• Parties: E. H. HALL, d/b/a the Parkhurst Nursing Home, Appellant, v. C. Leslie DAWSON, Commissioner Department of Economic Security et al., Appellees.
• Court: United States State Supreme Court — District of Kentucky

Page 366

429 S.W.2d 366

E. H. HALL, d/b/a the Parkhurst Nursing Home, Appellant, v. C. Leslie DAWSON, Commissioner Department of Economic Security et al., Appellees.

Court of Appeals of Kentucky.

June 14, 1968.

James L. Williams, William A. Young, Young & Williams, William P. Curlin, Hazelrigg & Cox, Frankfort, for appellant.

Paul E. Tierney, James G. Childers, Department of Economic Security, Robert F. Matthews, Atty. Gen., Frankfort, for appellees.

OSBORNE, Judge.

The appellant brought this action for a declaratory judgment in the Franklin Circuit Court to determine his right to payment under the Kentucky Medical Care Program and to enjoin the Department of Economic Security from withholding alleged overpayments. He is appealing from a judgment dismissing his complaint.

The appellant is the operator of a nursing home. In January, 1963, he sought to participate in the Kentucky Medical Care Program. There are three levels of payment for participating nursing homes based on the facilities and level of care they provide. A home desiring to participate must submit an application for the level at which it wishes to participate. If the application is accepted, a contract is signed in which the home agrees to meet the various requirements for that level and to notify the department if it is unable to meet the requirements. Thereafter, the home is authorized to accept and care for approved patients and is paid at the rate established. Appellant sought to participate at the Intermediate Rate Category and his application was approved. One of the requirements for participation at this rate was, 'The nursing staff of the nursing home shall maintain at least two full-time nurse employees who are either registered professional nurse(s) or licensed practical nurse(s).' Provisions were made for temporary noncompliance with this requirement. However, full compliance became mandatory July 1, 1964. Appellant received patients and was paid for their care at the Intermediate Rate during the period in controversy. He did not notify the Department that he was not meeting the requirements and in reply to letters requesting the names of his nurses, sent the name of two women employed.

The department, on the basis of inspection and affidavits, decided that appellant had not met the nursing requirements for the period from July 1, 1964 to August 31, 1965. They notified him that he had wrongfully received compensation at the Intermediate Rate and was entitled only to the lower Basic Rate for the entire period. They indicated that they would seek to recoup the difference by withholding future payments. Appellant objected to this determination and was granted a hearing on the matter by the Department even though there is no statutory provision authorizing it. At the hearing the Department produced proof to show that appellant had one full-time murse and one...