Pierce v. State, Dept. of Social Services

• Decision Date: 26 May 1998
• Docket Number: No. WD,WD
• Parties: In re the ESTATE OF Harley R. PIERCE, Deceased, James W. Pierce, Personal Representative, Appellant, v. STATE OF MISSOURI DEPARTMENT OF SOCIAL SERVICES, Respondent. 52743.
• Court: Missouri Court of Appeals

Page 814

969 S.W.2d 814

In re the ESTATE OF Harley R. PIERCE, Deceased, James W Pierce, Personal Representative, Appellant, v. STATE OF MISSOURI DEPARTMENT OF SOCIAL SERVICES, Respondent.

No. WD 52743.

Missouri Court of Appeals,

Western District.

May 26, 1998.

Douglass F. Noland, Norton, Norton & Noland, Kansas City, for appellant.

Lera L. Shemwell, Department of Social Services, Jefferson City, for respondent.

Before BRECKENRIDGE, P.J., and SMART and LAURA DENVIR STITH, JJ.

BRECKENRIDGE, Presiding Judge.

The Estate of Harley R. Pierce, through its personal representative, James W. Pierce, appeals from a $7,121.18 judgment in favor of the Department of Social Services on its claim against the estate for reimbursement of Medicaid expenses paid on behalf of Harley Pierce. The Estate contends that the trial court erred by granting the Department's claim because the Department failed to sustain its burden of proving that Mr. Pierce's medical services were medically reasonable and necessary or were incurred on his behalf. The Estate also contends that the trial court erred by failing to apply certain new provisions of § 208.215, RSMo Cum.Supp.1996, ¹ because the amended version of that statute involves procedural changes in Medicaid lien recovery and distribution which the Estate alleges are applicable retroactively to this case. This court finds that the Department sustained its burden of proving the amounts paid on Mr. Pierce's behalf. Additionally, although the amendment contained in § 208.215 is remedial in nature, it did not become effective until after the judgment was entered, so it will not be applied. The judgment of the trial court is affirmed.

The decedent, Harley R. Pierce, was a Medicaid recipient who made a total of five applications for public assistance benefits through the county office of the Division of Family Services. All were approved, although Mr. Pierce was required to "spend down" his resources until they were below the upper limit of eligibility for Medicaid health benefits. On August 30, 1991, while he was receiving Medicaid, Mr. Pierce broke his hip when he slipped and fell as he was leaving his dentist's office. Medicaid paid the cost of the medical services Mr. Pierce received for this injury. Mr. Pierce then brought a personal injury claim against the owner of the office as well as the dentist, but he died before resolution of his claim. After his death, the claim was settled through arbitration and the proceeds of the settlement were paid into Mr. Pierce's probate estate. The assets of the estate consisted solely of the proceeds from the settlement of the personal injury claim.

After the estate was opened, the Department filed a Medicaid claim for reimbursement of the Medicaid funds received by Mr. Pierce during his life. The Department's claim was filed pursuant to § 473.398, which creates a debt due the Department from a decedent's probate estate for all the public assistance funds paid to or on behalf of the decedent during his lifetime. Relying on this statute, the Department claimed a debt due in the amount of $7,121.18. The Estate contested the validity of the Department's claim and the case proceeded to trial in the Daviess County Circuit Court.

The trial on the Department's claim was held on February 8, 1996. At trial, the Department called two witnesses and offered several exhibits, including computerized Medicaid records. Susan Eggen, an estate recovery analyst with the Department, testified concerning the recordkeeping of the Department. She identified a document describing the cost data for the claim against the Estate. Relying on one of the computer-generated billing statements admitted into evidence as an exception to the hearsay rule under the Business Records Act, Ms. Eggen testified that the Estate owed the Department $7,121.18 for the Medicaid services it provided to Mr. Pierce. She arrived at this figure by matching Mr. Pierce's unique departmental identification number with expenses traced to that number. Ms. Eggen also testified that she was the custodian of these records and that Mr. Pierce's departmental identification number enabled her to accurately determine that $7,121.18 was spent on his behalf by the Department.

On cross-examination, the Estate questioned Ms. Eggen concerning her medical expertise. Ms. Eggen testified that she had no medical training, and that she had no personal knowledge of any medical treatment Mr. Pierce received or of his condition that necessitated the medical treatment. Furthermore, Ms. Eggen said that she could not judge whether any of the expenses incurred on behalf of Mr. Pierce were necessary or reasonable under any medical standard.

As its second witness, the Department called Debbie Hildenbrand, an income maintenance caseworker with the Division of Family Services. Ms. Hildenbrand described the general application procedure for Medicaid benefits. Ms. Hildenbrand testified that Mr. Pierce had applied for Medicaid benefits on five separate occasions and was approved each time, on the condition that he "spend down" his resources to fall within the upper limit of Medicaid eligibility. In addition, Ms. Hildenbrand identified a departmental client number as Mr. Pierce's unique identification on the application for Medicaid benefits. She also testified that once assigned, this number never changed. This identification number matched the one Ms. Eggen indicated and showed that Mr. Pierce had applied for public assistance benefits. On cross-examination, Ms. Hildenbrand admitted that she possessed no medical training or expertise and could not testify concerning the necessity or reasonableness of the medical treatment Mr. Pierce received or the medical condition that precipitated it.

After hearing arguments from both sides, the trial court took the matter under advisement. Neither party requested findings of fact or conclusions of law. In its order, dated April 10, 1996, the trial court found: "Upon argument of counsel and evidence presented, the Court finds that the estate is indebted on the claim in the amount of $7,121.18." The Estate filed a timely appeal from the trial court's order.

On appeal of a court-tried case, under Rule 73.01, this court upholds the trial court's judgment unless there was no substantial evidence to support it, it is against the weight of the evidence, or the court erroneously declared or applied the law. Vanderford v. Cameron Mut. Ins. Co., 915 S.W.2d 391, 392 (Mo.App.1996). In this case, there was no request for findings of fact or conclusions of law, and unless there is such a request and entry, "the trial court is presumed to have made findings in accordance with the decree entered and [its] judgment will be affirmed under any reasonable theory supported by the evidence...." Green Acres Enterprises, Inc. v. Freeman, 876 S.W.2d 636, 638 (Mo.App.1994).

As its first point on appeal, the Estate complains that the trial court erred by allowing the Department's claim for $7,121.18 because the Department failed to sustain its burden of proving that the Medicaid expenses were medically necessary and reasonable under the circumstances or that they were for the benefit of Mr. Pierce. The Estate argues that pursuant to relevant statutory and case law, the Department must prove that the Medicaid expenses were medically necessary and reasonable and for the benefit of the Medicaid recipient before the Department may recover any benefits paid on behalf of a claimant.

The Department's claim was filed pursuant to § 473.398, which allows the Department to recoup Medicaid benefits paid from a decedent's estate when a Medicaid recipient dies. The relevant provisions of § 473.398 are as follows:

1. Upon the death of a person, who has been a recipient of aid, assistance, care, services, or who has had moneys expended on his behalf by the department of health, department of social services, or the department of mental health, or by a county commission, the total amount paid to the decedent or expended upon his behalf after January 1, 1978, shall be a debt due the state or county, as the case may be, from the estate of the decedent.

* * *

4. Claims consisting of moneys paid on behalf of a recipient ... shall be allowed ... upon the showing by the claimant of proof of moneys expended. Such proof may include but is not limited to the following items which are deemed to be competent and substantial evidence of payment:

(1) Computerized records maintained by any governmental entity as described in subsection 1 of this section of a request for payment for services rendered to the recipient; and

(2) The certified statement of the treasurer or his designee that the payment was made.

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Under this statute, the Department had the burden of proving the "total amount paid" to the decedent or expended upon his behalf. Section 473.398.1. Here, the Department presented records detailing the amounts paid to Mr. Pierce or on his behalf in the form of Medicaid benefits and the services provided to Mr. Pierce. These computer records were not only entered into evidence but were verified by the testimony of the estate recovery analyst and income maintenance caseworker. This evidence is sufficient to satisfy the Department's burden of proof in an action to recoup Medicaid benefits. See Dept. of Social Services v. Ragsdale, 934 S.W.2d 322, 323-24 (Mo.App.1996).

The Estate argues that the Southern District's opinion in State, Department of Social Services v. Beckner, 813 S.W.2d 353 (Mo.App.1991), requires a ruling in its favor. In Beckner, the court affirmed the trial court's ruling that the Department had failed to produce sufficient evidence in order to prevail on its action to recover public assistance benefits from the estate of a Medicaid recipient. Id. at 355. In so doing, the court held that the Department failed to meet its burden of proof by merely submitting a stack of documents without an explanation "as to...