STATE OF NORTH CAROLINA
COUNTY OF WAKE
IN THE OFFICE OF
ADMINISTRATIVE HEARINGS
09 DHR 2779
.
MELONIE L. KEITH )
JOHN DAVID KEITH )
Petitioner )
)
v. )
)
CENTRAL BILLING, )
DHHS CONTROLERS OFFICE )
)
Respondent )
ORDER GRANTING SUMMARY
JUDGMENT FOR RESPONDENT
FINDINGS OF FACT
This petition for contested case was filed on April 23, 2009. This matter was heard by the
undersigned Administrative Law Judge on September 2, 2009, in Raleigh, North Carolina. Prior to hearing testimony from the witnesses, the undersigned Administrative Law Judge heard arguments concerning Respondent’s Motion for Summary Judgment which was filed on July 31, 2009. After hearing the arguments from both parties, the undersigned Administrative Law Judge hereby GRANTS the motion for the following reasons.
1. Petitioners’ daughter was treated by Respondent DHHS in Dorothea Dix Hospital on
an outpatient basis. The dates of service were from January 6, 2006 to February 3, 2006
for a total of 5 ½ hours. The hourly cost of care was $88.00 for 4 visits and $66.00 for 2 visits;
thus the total cost of care for this treatment was $484.00. Blue Cross Blue Shield Insurance paid
$154.00, leaving a balance of $330.00.
2. On January 27, 2006, Petitioner Melonie L. Keith signed the Ability to Pay (ATP) agreement agreeing to pay $5.00 an hour of the balance that insurance did not pay. The language in that agreement clearly states that if there is a default in payment, full charges may accrue on the account. Therefore, Petitioner’s ATP cost was $ 127.50.
3. Bills were sent to the Petitioners at 6800 Marksman’s Way, Cary NC 27519 on April 2, 2006, May 2, 2006, June 2, 2006, July 2, 2006, August 2, 2006, September 2, 2006, and
October 2, 2006. None of the bills were returned. No family payments were ever made. Petitioners argued that they never received these bills. The above address was given to the Respondent upon their child’s admission for outpatient treatment. In addition, this is the same address on the Petition and in the notice of debtor letter dated March 24, 2009, which was the agency action that prompted the petition.
4. The Petitioners admitted in open court to facts in Respondent’s Motion for Summary Judgment. Their only argument was that if Respondent had billed Blue Cross/ Blue Shield correctly, the insurance would have paid the total bill. Respondent argued that the insurance would only pay for the child’s treatment but not the parents’ sessions. Another reason for the denial was that the Petitioner owed copayments as indicated in the documentation that accompanied the petition.
CONCLUSIONS OF LAW
1. Pursuant to N.C.G.S. §143-117, all persons admitted to and receiving care from a state facility are required to pay the actual cost of their care, treatment, training and maintenance.
2. Pursuant to N.C.G.S. §105A, the debt setoff Collection Act, Respondent DHHS must submit debts owed to it to the Department of Revenue for setoff if the amount is over $50.00.
3. If the obligor defaults in paying the compromised amount, then full charges shall accrue. N.C.G.S. §143-118 (e)
4. Petitioner did receive proper notice about the ATP amount being owed and failed to make any payments and the fact that such a default would mean that full charges would be put on the account.
DECISION
Based upon the foregoing Findings of Fact and Conclusions of Law, the undersigned hereby Grants Respondents Motion for Summary Judgment. Petitioner owes Respondent the sum of $330.00 for the cost of their daughter’s care. Therefore, Respondent is entitled to keep full tax refund of $330.00.
NOTICE AND ORDER
The North Carolina Department of Health and Human Resources will make the final Decision in this contested case. Pursuant to N.C. Gen. Stat. § 150B-36(b), (b1), (b2) and (b3) enumerate the standard of review and procedures the agency must follow in making its Final Decision, and adopting and/or not adopting the Findings of Fact and Decision of the Administrative Law Judge.
Pursuant to N.C. Gen Stat. § 150B-36(a), before the agency makes a Final Decision in this case, it is required to give each party an opportunity to file exceptions to this decision and to present written arguments to those in the agency who will make the Final Decision. N.C. Gen. Stat. § 150B-36(b)(3) requires the agency to serve a copy of the Final Decision on each party, and to furnish a copy of the Final Decision to each party’s attorney of record and to the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714.
______
Joe Webster
Administrative Law Judge
A copy of the foregoing was mailed to:
Paul Avery Morton II
3921 Pearl Avenue
Sophia, NC 27350-8873
Petitioner
Janette Soles Nelson
Assistant Attorney General
N.C. Dept. of Justice
PO Box 629
Raleigh, NC 27602-0629
Counsel for Respondent
This the _ day of October, 2009.
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714
4