Hunt v. Mercy Med. Ctr.
2011 Ohio 3678
Ohio Ct. App.2011Background
- Hunt sued Mercy Medical Center after receiving Medicaid-covered care costing $227.91.
- Mercy allegedly billed Hunt directly and failed to obtain her pre-service consent to bill Medicaid.
- Hunt claimed Mercy violated Ohio Medicaid billing regulations by seeking third-party payer information.
- The trial court granted Civ.R. 12(B)(6) dismissal, holding the letter a request for information, not a bill.
- Court affirmed dismissal, concluding no private right of action under federal Medicaid law or Ohio law for such claims.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is the Mercy letter a bill violating Medicaid billing rules? | Hunt asserts the letter is a bill demanding payment. | Mercy contends the letter is a subrogation information request, not a bill. | Letter not a bill; no violation stated. |
| Does Hunt have standing to sue under Medicaid regulations? | Hunt claims breach of contract and negligence via Medicaid regs. | No private right under federal Medicaid law and ORC 5111.102. | No standing; dismissal proper. |
Key Cases Cited
- Davis v. Widman, 184 Ohio App.3d 705 (2009-Ohio-5430) (review of Civ.R. 12(B)(6) de novo; pleadings rule)
- LeRoy v. Allen, Yurasek, & Merklin, 114 Ohio St.3d 323 (2007-Ohio-3608) (Civ.R. 12(B)(6) standard; pleadings must state a claim)
- State ex rel. Hanson v. Guernsey Cty. Bd. of Commrs., 65 Ohio St.3d 545 (1992) (test for failure to state a claim; use of evidence outside complaint prohibited)