Novitsky v. Department of Public Welfare
42 A.3d 1165
| Pa. Commw. Ct. | 2012Background
- OIG determined Recipient was ineligible for MA long-term care due to unreported transfers of $663,387.05 by her husband.
- Department paid $72,538.28 in benefits on Recipient’s behalf for Oct 2008–Sep 2009.
- ALJ held two hearings, extended time to prove funds were not owned by Recipient or husband, and required documentation.
- Recipient’s representatives failed to show any funds were not owned by husband or restricted, despite multiple opportunities.
- Secretary, on reconsideration, upheld the BHA order and clipped overpayment claim; Commonwealth Court affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Did unreported transfers by husband render Recipient ineligible? | Recip not owner of funds; transfers not attributable to Recipient. | Transfers were owned by Recipient's husband; funds were available to Recipient. | Yes; funds owned by husband made Recipient ineligible |
| May the Department recover the overpayment from the recipient under 62 P.S. § 1408(c)(6)(i)? | Overpayment should be pursued elsewhere or limited by equity. | statute permits recovery from recipient; proper amount to recover determined by unreported assets. | Department may recover from Recipient; amount tied to unreported assets |
| Are equitable arguments a defense to overpayment? | Equitable considerations negate recovery or shift liability. | Equity cannot defeat a statutory overpayment claim. | Equitable arguments rejected; statute governs |
Key Cases Cited
- Godown v. Department of Public Welfare, 813 A.2d 954 (Pa.Cmwlth.2002) (income/resources rule for MA eligibility)
- Bird v. Pennsylvania Department of Public Welfare, 731 A.2d 660 (Pa.Cmwlth.1999) (resources as part of eligibility analysis)
- Ptashkin v. Department of Public Welfare, 731 A.2d 238 (Pa.Cmwlth.1999) (resources and eligibility standards)
- Lancashire Hall Nursing & Rehabilitation Center v. Department of Public Welfare, 995 A.2d 540 (Pa.Cmwlth.2010) (resources and community spouse allowance context)
- LaFond v. Department of Public Welfare, 933 A.2d 159 (Pa.Cmwlth.2007) (overpayment recovery and ownership burden)
- Maloy v. Department of Public Welfare, 998 A.2d 661 (Pa.Cmwlth.2010) (recoverability of overpayment under §1408(c)(6)(i))