Hunt v. Mercy Med. Ctr.Hunt v. Mercy Med. Ctr.
For Plaintiff-Appellant: ALBERTO NESTICO 0071676, GARY KISLING 0003438, TODD ROSENBERG 0037401, Kisling, Nestico, & Redick, LLC, 3412 W. Market St., Akron, Ohio 44333
For Defendant-Appellee: JOHN N. CHILDS 0023489, ADAM D. FULLER 0076431, Brennan, Manna & Diamond, LLC, 75 E. Market St., Akron, Ohio 44308
{¶1} Plaintiff-Appellant, Lisa Hunt, appeals from the judgment of the Stark County Court of Common Pleas, dismissing her complaint against Appellee, Mercy Medical Center for failure to state a claim upon which relief can be granted pursuant to
{¶2} The basis for the complaint is that Appellant received medical services from Appellee following a car accident. The cost of the medical services was $227.91. Appellant was eligible for Medicaid benefits and the services that she received from Appellee were covered by Medicaid. Appellant alleged that she was not informed by Appellee in writing that she would be billed for the medical services and not Medicaid. She also alleged that she did not agree to pay for the medical services prior to those services being rendered.
{¶3} On November 3, 2009, Paula Dreyfuss, of the law firm of Dreyfuss, Williams, & Associates Co., LPA, sent a letter to Appellant‘s personal injury attorney, Gary Kisling, at Kisling, Nestico, & Redick, LLC, notifying attorney Kisling of her firm‘s representation of Appellee and explaining that Appellee was required by law to identify and collect from third parties, such as automobile insurers before billing Medicaid for services covered by Medicaid. She also requested that Kisling provide her with information on the existence of insurance covering medical claims arising from Hunt‘s car accident.
{¶4} Appellant, in a class action complaint, alleged that this was a “written request for payment” and argued that Appellee violated Ohio Medicaid Billing regulations,
{¶5} Appellee filed a motion to dismiss Appellant‘s complaint on October 29, 2010. Appellant requested leave to amend her complaint, and leave was granted. Appellee filed a motion to dismiss Appellant‘s first amended complaint pursuant to
{¶6} Appellant raises two Assignments of Error:
{¶7} “I. THE TRIAL COURT ERRED IN HOLDING THAT APPELLANT WAS NOT BILLED AND THAT THE DOCUMENT ATTACHED TO THE FIRST AMENDED COMPLAINT AS EXHIBIT A IS NOT A BILL.
{¶8} “II. THE TRIAL COURT ERRED IN HOLDING THAT APPELLANT HAS NO CAUSE OF ACTION UNDER THE OHIO ADMINISTRATIVE CODE SINCE APPELLANT‘S CLAIM FOR BREACH OF CONTRACT IS BASED ON EXPRESS CONTRACT LANGUAGE AND APPELLANT‘S CLAIM FOR NEGLIGENCE IS BASED ON A DUTY INDIRECTLY DERIVED FROM THE ADMINISTRATIVE CODE.”
{¶9} In Appellant‘s assignments of error, she argues that the trial court erred in dismissing her Amended Complaint. We disagree.
{¶10} A trial court‘s order granting a motion to dismiss is reviewed de novo by the appellate court. Davis v. Widman, 184 Ohio App.3d 705, 714, 2009-Ohio-5430, 922 N.E.2d 272.
{¶11} “A motion to dismiss for failure to state a claim upon which relief can be granted is procedural and tests the sufficiency of the complaint.” State ex rel. Hanson v. Guernsey Cty. Bd. of Commrs. (1992), 65 Ohio St.3d 545, 548, 605 N.E.2d 378, citing Assn. for Defense of Washington Local School Dist. v. Kiger (1989), 42 Ohio St.3d 116, 117, 537 N.E.2d 1292.
{¶12} Accordingly, a trial court may not rely upon evidence or allegations outside the complaint when ruling on a
{¶14} The trial court‘s judgment entry granting the
{¶15} “On May 9, 2009, Plaintiff Lisa Hunt was injured in an automobile accident and sought care from Defendant Mercy Medical Center. She was eligible for Medicaid. She was provided care costing $227.91. She was later sent a letter which she claims is a “written request for payment” to her for Medicaid covered services. In reliance of this letter, Plaintiff alleges that Mercy billed her directly for medical services covered by Medicaid, which practice would be in contravention of Medicaid law.
{¶16} “Letter is Not a Bill
{¶17} “Plaintiff characterizes the letter attached to the Complaint as a bill demanding payment for Medicaid covered services. However, the content of the letter makes it clear that it is not a bill. The letter, sent by Mercy‘s attorney to Plaintiff‘s attorney, is a request for information about the existence of a third party payer. The letter makes the following request:
{¶18} “Please provide me with any and all insurance information, including possible medical benefits through your client‘s automobile insurance, so that the bill may be submitted for processing. If there is no other health or auto coverage, please provide either a denial or exhaust letter so that Medicaid can be billed.
{¶19} “As explained in the letter, Medicaid is a payer of last resort, and Mercy was required by law to take reasonable measures to obtain payments for Medicaid covered services from third parties before billing Medicaid.
{¶20} “In considering dismissal, the Court should accept Plaintiff‘s factual allegations as true and draw all reasonable inferences in favor of the non-moving party. However, unsupported conclusions made in the Complaint are not accepted as true. The inference that the letter is a bill is not reasonable. As such, Plaintiff has not alleged
sufficient facts to show that Mercy improperly billed her for medical serviced [sic] covered by Medicaid. {¶21} “Plaintiff Lacks Standing
{¶22} “Even if the Court were to construe the letter as a bill, Plaintiff nonetheless lacks standing to assert her claims. Plaintiff‘s claims are premised on Ohio Medicaid regulations outlining when a Medicaid services provider, like Mercy, may bill a Medicaid recipient, like Plaintiff. The Ohio Medicaid statute expressly states that its provisions cannot be construed to create a cause of action to enforce state law beyond the causes of action available under federal Medicaid law. Under federal Medicaid law, no private cause of action exists for a Medicaid recipient. Since there is no private right of action for Medicaid recipients under federal law, there can be no private cause of action for Medicaid recipients under federal law, there can be no private cause of action for a Medicaid recipient under Ohio law pursuant to
O.R.C. 5111.102 .{¶23} “Plaintiff attempts to work her way around this prohibition by asserting common law causes of action for breach of contract and negligence. These causes of action, however, are based solely on alleged violations of Ohio Medicaid provider billing regulations. In order to resolve these claims, the Court would have to specifically determine whether Mercy violated Ohio Medicaid regulations. Thus, these claims are subject to dismissal in the same manner as a statutory cause of action under Medicaid.
{¶24} “In limiting review to the pleadings as prescribed by Civil Rule 12(B)(6), this Court finds that the allegations made in Plaintiff‘s Complaint are not legally sufficient to state a claim upon which relief can be granted.
{¶25} “Accordingly, it is hereby ORDERED, ADJUDGED, and DECREED that Defendant‘s Motion to Dismiss is hereby GRANTED. This is a final appealable order and there is no just cause for delay.” (Internal citations omitted).
{¶26}
{¶27} The letter states, specifically:
{¶28} “Please provide me with any and all insurance information, including possible medical benefits through your client‘s automobile insurance, so that the bill may be submitted for processing. If there is no other health or auto coverage, please provide either a denial or exhaust letter so that Medicaid can be billed.”
{¶29} Moreover, we find that the trial court properly concluded that Appellant did not have standing to assert her breach of contract and negligence claims against Appellee based on
{¶30} “As used in this section, “state agency” has the same meaning as in section 9.23 of the Revised Code.
{¶31} “No provision of Title LI of the Revised Code or any other law of this state that incorporates any provision of federal Medicaid law, Title XIX of the Social Security
{¶32} Under federal law, no private cause of action exists for a Medicaid recipient to sue a Medicaid provider. Stewart v. Bernstein (5th Cir. 1985), 769 F.2d 1088, 1093; Harmon v. St. Augustine Manor (N.D. Ohio Apr. 5, 2007), No. 1:06cv2845, 2007 WL 1072164; Fuzie v. Manor Care, Inc. (N.D. Ohio 1977) 461 F.Supp. 689, 696.
{¶33} Moreover, pursuant to the passage of
{¶34} Accordingly, we find that the trial court acted properly in granting Appellee‘s motion to dismiss for failure to state a claim upon which relief could be granted pursuant to
{¶35} Appellant‘s assignment of error is overruled.
By: Delaney, J.
Hoffman, P.J. and
Farmer, J. concur.
HON. PATRICIA A. DELANEY
HON. WILLIAM B. HOFFMAN
HON. SHEILA G. FARMER
For the reasons stated in our accompanying Memorandum-Opinion on file, the judgment of the Stark County Court of Common Pleas is affirmed. Costs assessed to Appellant.
HON. PATRICIA A. DELANEY
HON. WILLIAM B. HOFFMAN
HON. SHEILA G. FARMER