Scull v. Doctors Groover, Christie & Merritt, P.C.
2012 WL 2047498
Md. Ct. Spec. App.2012Background
- Scull, an HMO enrollee, was referred to GCM for knee x-rays in 2008; GCM billed Scull in 2009 for $121 after partial insurance payment.
- UHC had paid some portion of the x-ray cost; GCM claimed balance due due to secondary payer status and coordination of benefits.
- HCMG advised Scull to submit to Medicare; UHC informed Scull that a payment had been made to GCM.
- Scull paid the $121 after being told to disregard invoices; GCM later refunded $121 after an audit.
- Scull sued in Montgomery County Circuit Court, asserting HMO Act, Consumer Protection Act, and unjust enrichment claims; court dismissed with prejudice after motions to dismiss.
- Scull appealed, challenging the circuit court’s ruling on HMO Act applicability, CPA exemption, alleged CPA violations, and unjust enrichment.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether HMO Act allows private action against a provider | Scull contends the HMO Act implies a private remedy | GCM argues no private action; Act applies only to HMOs | No implied private action; Act applies to providers; Count 1 dismissed |
| Whether HMO Act exempts GCM from liability under private action | Scull argues exemption does not apply to providers | GCM argues no private remedy exists; exemption applies to enforcement by commissioner | HMO Act does not create private remedy; no private accountability for GCM |
| Whether GCM’s billing constitutes unfair/deceptive CPA practice | Scull asserts billing for covered services violates CPA | GCM argues CPA exempts professional services from billing; no CPA claim | CPA does not apply; professional services exemption applies; Count 2 dismissed |
| Whether GCM was unjustly enriched by Scull’s payment | Scull paid under belief of balance due; enrichment occurs | GCM refunded once discovered; enrichment not proven as benefit retained | Unjust enrichment not proven; refund negates enrichment; Count 3 dismissed |
Key Cases Cited
- Erie Ins. Co. v. Chops, 322 Md. 79 (Md. 1991) (factors for implied private remedy; legislative intent emphasized)
- Sugarloaf Citizens Assoc., Inc. v. Gudis, 78 Md.App. 550 (Md. 1989) (legislative history weighed lightly; private remedy may be implied in some statutes)
- IVTX, Inc. v. United Healthcare of the Mid-Atlantic, Inc., 112 F. Supp. 2d 445 (D. Md. 2000) (legislative history and implied remedies; caution with silence in history)
- Widgeon v. Eastern Shore Hosp. Ctr., 300 Md. 520 (Md. 1984) (statutory remedies; public policy considerations)