United States District Court, E.D. Michigan, Southern Division
ORDER GRANTING DEFENDANT'S MOTION FOR SUMMARY
JUDGMENT [ECF No. 42]
GEORGE
CARAM STEEH, UNITED STATES DISTRICT JUDGE
Plaintiff,
The White House Services, provides medical services to Edwin
Broadus, who sustained catastrophic brain injuries in a motor
vehicle collision occurring November 1, 1982. In this action,
plaintiff seeks to collect no-fault personal protection
insurance benefits from defendant Allstate Insurance under
Michigan's No-Fault Automobile Insurance Act
(“No-Fault Act” or “Act”) and an
automobile insurance policy. Specifically, plaintiff seeks to
recover for services provided to Mr. Broadus while he was a
resident in a single person apartment from January 21, 2016
through January 31, 2018.
The
matter is presently before the court on defendant's
motion for summary judgment. Defendant argues that plaintiff
did not provide lawfully rendered services to Mr. Broadus for
which it is entitled to Michigan no-fault benefits.
Specifically, defendant alleges that plaintiff did not
possess the required license to provide adult foster care
services in a single apartment setting and therefore its
services are not compensable under the No-Fault Act. Oral
argument was heard by the court on October 7, 2019.
FACTUAL
BACKGROUND
The
White House Services is owned by Jacquelyn Vaughn. She
started operating The White House Services in 2006 by
offering geriatric in-home services and then transitioned
into offering services for people who suffered traumatic
brain injuries in motor vehicle accidents. The White House
Services is licensed as an adult foster care home for
services provided at 5466 Greenbriar (“Group
Home”) and is restricted to having six clients at a
time at the home.
The
White House Services also offers a “residential
program” for individuals who live offsite. In 2012, the
Michigan Department of Human Services Bureau of Children and
Adult Licensing (“Department”) undertook an
investigation into The White House Services. The
investigation focused on the services provided to
“Resident A” who lived in one of plaintiff's
single person apartments. On April 23, 2012, the Department
concluded that adult foster care was being provided to
Resident A at the apartment without a license. The Department
also found that “Resident A's care plan is directed
towards total rehabilitation, full independence and eventual
release from the support of the servicing insurance
company.” PageID 825. After concluding that Resident A
did not require the adult foster care services normally
provided by plaintiff's Group Home, the Department
directed Ms. Vaughn to form a new entity to service
rehabilitative clients who are working toward independent
living. This new entity was White House Custom Services, and
its purpose was “[t]o clarify the differences [between
adult foster care services provided by the Group Home and
rehabilitative services provided in the single apartment
setting], avoid the appearance of impropriety and maintain
services and funds apart from the licensed group home . . .
.” PageID 825. The Department required a doctor's
statement supporting a high probability for rehabilitation in
order for rehabilitative services to be provided in the
single apartment setting without a license. Following the
investigation, Vaughn established The White House Custom
Services as the entity that services “[a]ny future
business outside White House Services group home . . .
.” PageID 825.
Vaughn
affirmed in her deposition that The White House Services'
adult foster care license does not cover the services
provided offsite for the residential program. (Vaughn Dep.,
p. 19). Susan Schmidt is the accountant for The White House
Services and The White House Custom Services. Schmidt
explained that the two entities file joint tax returns and
the accounts receivable for the two entities are commingled.
Further, the staff providing the services is shared by the
two entities. In their depositions, plaintiff's employees
often referred to the two entities generally as “The
White House”.
On
January 21, 2016, Edwin Broadus moved into a single resident
apartment located at 29700 Citation Circle, Farmington Hills,
Michigan (the “Citation Circle Apartment”). The
rent for the apartment is included in the per diem rate
plaintiff charged for services provided to Broadus. Plaintiff
identified employees Dara Ladd and Mia Banks as Broadus'
two primary caregivers. Ladd provided services at the
Citation Circle Apartment on Mondays through Fridays from
8:00 a.m. to 4:00 p.m. These services included: attending
Broadus' medical appointments; preparing meals with food
purchased by The White House; administering medications;
assisting while out in the community; ensuring someone at The
White House is aware of his whereabouts; overseeing dressing
and hygiene; assuring his health, safety and well-being; and
protecting him against physical harm, humiliation and
intimidation. These services were offered and available to
Broadus 24 hours a day, seven days a week. Ladd further
explained that Broadus spent nights at the Citation Circle
Apartment but regularly went to the Group Home during the
day, so he could interact with other clients.
Mia
Banks testified she provided services to Broadus on Monday,
Wednesday and Friday from 4:00 p.m. to 9:00 p.m. at the
Citation Circle Apartment. During her shift she provided the
following services: assistance with showering, dressing and
hygiene; meal preparation; administering medications;
activities such as taking walks and going out in the
community; reminding him of activities to be completed;
protecting his health, safety and well-being; and making sure
someone from The White House always knows of his whereabouts.
Paulette
Boggs is the human resources and account manager for The
White House. She confirmed that The White House is always
aware of Mr. Broadus' whereabouts, and that services are
available to him 24 hours a day, seven days a week. As a
rule, caregivers were to provide assistance with: meal
preparation; activities of daily living; dressing in proper
clothing; development of personal and social skills; and
ensuring his health, safety and well-being.
The
caregivers document the services they provide on records that
comprise each resident's chart. For Mr. Broadus, these
records document the following services: grooming support;
administration of medications; preparation of meals;
assessments regarding behavior; household chores; and
attendance at doctor appointments. Plaintiff produced records
titled “Rolling Rehab Recreation, ” which show
that caregivers provided “social integration
activity” for Mr. Broadus. This includes taking Broadus
on outings in the community, so he could work on developing
personal and social skills.
The job
description for Care Specialist/Home Health Aide at The White
House Services lists the following services provided to
clients: medication reminders; escorts to appointments; meal
planning and preparation; assistance with bathing, dressing
and grooming; running errands; and engaging in physical and
mental exercise. Each of these services was provided to Mr.
Broadus.
Plaintiff
seeks to recover for services provided to Mr. Broadus while
he was a resident at the Citation Circle Apartment from
January 21, 2016 through January 31, 2018. Mr. Broadus moved
into the Group Home on February 1, 2018 and the parties agree
that defendant has paid plaintiff for services provided and
billed since that date. Defendant moves for summary judgment,
contending that plaintiff is not entitled to reimbursement
under the No-Fault Act because it was operating as an
unlicensed adult foster care facility and was therefore not
lawfully rendering treatment under Michigan's No-Fault
Act. Plaintiff responds by arguing that defendant has not
offered any proof that The White House Custom Services was
required to have a license under the Adult Foster Care
Facilities Licensing Act to lawfully provide its services and
accommodations to Mr. Broadus in a single apartment setting.
STANDARD
FOR ...