Scull v. Groover, Christie & Merritt, P.C.
76 A.3d 1186
Md.2013Background
- MD HMO Act prohibits balance billing; members owe no debt for covered services.
- Petitioner Scull, an HMO member, was billed by GCM for an x-ray of his knee.
- HMO paid GCM; later billing inconsistencies and refunds prompted scrutiny.
- Complaint asserted an implied private right of action under the HMO Act and a CPA claim for unfair/deceptive practices.
- Circuit Court dismissed the HMO Act claim and later dismissed amended CPA claim with prejudice; Court of Special Appeals affirmed.
- Maryland high court reversed in part, holding no implied private action under HMO Act but permitting CPA claim against billing practices.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether there is an implied private right of action under the HMO Act. | Scull seeks private remedy for balance billing. | GCM argues no implied right under the statute. | No implied private action under HMO Act. |
| Whether medical billing practices are exempt from the CPA as professional services. | Billing falls outside professional services exemption. | Billing is within professional services exemption. | Billing not exempt; CPA claim viable. |
Key Cases Cited
- Baker v. Montgomery County, 427 Md. 691 (Md. 2012) (test for implied private rights of action)
- Cort v. Ash, 422 U.S. 66 (U.S. 1975) (three-factor test for implied private rights of action)
- Riemer v. Columbia Medical Plan, Inc., 358 Md. 222 (Md. 2000) (balance billing context; HMO structure)
- Swam v. Upper Chesapeake Medical Center, 397 Md. 528 (Md. 2007) (professional services vs. billing actions; limitations)
- Hogan v. Maryland State Dental Ass’n, 155 Md.App. 556 (Md. 2004) (professional services exemption scope)
- Converge Services Group, LLC v. Curran, 383 Md. 462 (Md. 2004) (administrative interpretation of CPA; billing practices)