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Papciak v. Sebelius

742 F. Supp. 2d 765 (2010)

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Papciak v. Sebelius

United States District Court for the Western District of Pennsylvania

742 F. Supp. 2d 765 (2010)

Facts

Wanda Papciak (plaintiff), 81 years old, was admitted to ManorCare, a skilled nursing facility (SNF), for daily physical and occupational therapy following a hip replacement. When Papciak was admitted, she was unable to walk, even with a walker, and suffered from depression and anxiety. Papciak was admitted to ManorCare from June 3, 2008, through July 19, 2008. After being discharged, Papciak received additional physical and occupational therapy at Baldwin Health Center through August 21, where she reportedly met her therapeutic goals, showed good recovery potential, and progressed to walking with the aid of a walker. Papciak’s doctors also noted that her mental condition improved and that she was active and cooperative in her therapy. Medicare refused to cover Papciak’s care after July 10, stating that Papciak’s progress was minimal and that she had reached her maximum recovery potential. Accordingly, Medicare held that all care Papciak received after July 10 was custodial care, which is not covered by Medicare. Papciak appealed the denial, but it was ultimately upheld as the secretary of Health and Human Services’ (defendant) final decision. Papciak petitioned the district court for review of the secretary’s decision, arguing that the secretary (1) improperly based the denial of coverage on Papciak’s failure to materially improve; (2) failed to consider Papciak’s need for a rehabilitative maintenance program; (3) failed to consider the effect of Papciak’s depression and anxiety on her recovery speed; and (4) ignored evidence of Papciak’s physical and occupational improvement.

Rule of Law

Issue

Holding and Reasoning (Bissoon, J.)

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