writing sample 2 [legal memo on unpaid medical bills]

Download Writing sample 2 [legal memo on unpaid medical bills]

Post on 19-Aug-2015

76 views

Category:

Law

2 download

Embed Size (px)

TRANSCRIPT

  1. 1. 1 MEMORANDUM To: Patty Hopper, Legal Research From: James A. Alp, UDSL Student Extern Date: September 24, 2012 Subject: Judgment in v. , No. 2012-CVF- QUESTION PRESENTED Under case law governing an action by a medical service provider to collect on a patients account, is a plaintiff entitled to judgment in its favor when its sole witness, plaintiffs billing specialist, introduces an account statement into evidence, but admits on cross-examination that she has no personal knowledge of the medical necessity of plaintiffs services or the reasonableness of plaintiffs fees, whereas the defendant produces no exhibits and calls no witnesses in support of his defense that the plaintiffs fees are unreasonable? FACTUAL AND PROCEDURAL HISTORY This is an action on an account for professional services rendered. Defendant , after suffering an injury while employed by , received treatment from Plaintiff , which services and treats workers compensation patients. Pl.s Post-Trial Br. 1. The Ohio Bureau of Workers Compensation (BWC) was billed for Defendants treatment, but the claims were denied. Id. Plaintiff then attempted to collect payment personally from the Defendant, who never paid on the account. Plaintiff filed its Complaint on , 2012. The Complaint alleged one cause of action, specifically, that Defendant owed Plaintiff the sum of $, upon an account. Compl. 1. In accordance with Civ.R. 10(D)(1), Plaintiff attached to its Complaint a copy of its
  2. 2. 2 Claim Summary Invoice showing Defendants name, a list of services provided with dates of service and Plaintiffs adjusted rates, and the total balance of $ due and owing Plaintiff. On , 2012, Defendant filed his Answer, including a general denial and asserting, among other defenses, that the charges incurred herein for medical services rendered on behalf of Defendant are unconscionable and unreasonable. Answer 1, 14. A trial was held in this Court on , 2012. Plaintiffs sole witness, Ms. J , who has been employed by Plaintiff as a billing specialist for three years, testified as to the Claim Summary Invoice at issue. Pl.s Post-Trial Br. 2. She testified that she was familiar with the Defendant and had personal knowledge of his account, and that the charges on the account were for services rendered to the Defendant. Id. She testified that the adjusted rates billed by Plaintiff were determined by its fee reduction agreement with the BWC, so that the amount Plaintiff billed Defendant as a self-pay was no more than the rates allowed by the BWC. Id. at 3. Ms. testified that she spoke with the Defendant and that he either accepted a payment arrangement on the account or offered to make a $10.00 monthly payment. Compare Pl.s Post-Trial Br. 3 with Def.s Post-Trial Br. 3. At any rate, her testimony was that during their conversation the Defendant did not dispute the account or the services with her. Pl.s Post- Trial Br. 3. Plaintiff introduced no other exhibits, such as medical records which might substantiate the medical care that was provided to Defendant, or the effects of such treatment. Def.s Post-Trial Br. 2. No treating physician or physical therapist testified as to the reasonableness or necessity of the claimed charges. Id. The Defendant appeared at trial but did not testify, offered no exhibits, and called no witnesses. Defendants counsel did cross-examine Ms. , who admitted that she was not
  3. 3. 3 aware of any written agreement for services or charges signed by Defendant. Def.s Post-Trial Br. 2. Ms. testified that the Defendant may have executed a document authorizing service and agreeing to pay for the services rendered, but Plaintiff failed to produce any such document at trial. Pl.s Post-Trial Br. 2. Ms. also admitted that she was not present when any of the services were provided to the Defendant, nor was she aware whether or not the treatments actually benefited his medical condition. Def.s Post-Trial Br. 2. At the conclusion of the trial, the Court requested post-trial briefs from both parties. Defendants post-trial brief maintains that the Plaintiff failed to prove by a preponderance of the evidence that the medical services provided to Defendant were customary, reasonable and necessary. Plaintiffs post-trial brief maintains that it met its burden of a preponderance of the evidence and that it is entitled to judgment against the Defendant for the amount prayed for in its complaint, $. Plaintiff argues that it met its burden by introducing its medical bills, and that the Defendant failed to meet his burden by failing to introduce evidence that Plaintiffs charges were unreasonable. ANALYSIS I. Even though Plaintiff presented no evidence that the amount it billed was reasonable, the conclusion that it has met its burden of proof cannot be avoided. A. A Physician is entitled to collect the reasonable value of services rendered, but has the burden of establishing reasonable value. Plaintiff herein has brought an action on an account, which is an action for a breach of contract.1 Oxford Sys. Integration, Inc. v. Smith-Broughan Mechanical Servs., 159 Ohio App.3d 1 Defendant emphasizes in his Post-Trial Brief that Plaintiff did not plead quantum meruit in its Complaint. Def.s Post-Trial Br. 1. In fact, quantum meruit (literally, as much as he deserves, Lebanon Country Manor Nursing Home v. Stiver, No. 88-04-030, 1989 WL 33706, *3 [12th Dist. Apr. 10, 1989]), is simply the name for the measure of damages afforded in an action for quasi-contract. Dailey v. Craigmyle & Son Farms, L.L.C., 177 Ohio App.3d 439, 2008-Ohio-4034, 20 (4th Dist.). See also Myers v. Good, 4th Dist. No. 06CA2939, 2007-Ohio-5361, 12 (quantum meruit described as proper remedy for unjust enrichment). A party is not required to plead its legal
  4. 4. 4 533, 2005-Ohio-210, 824 N.E.2d 586, 16 (2d Dist.). The physician-patient relationship is characterized as a contract, whether express or implied. Associated Physicians of MCO, Inc. v. Baker, 6th Dist. No. L-89-209, 1990 WL 106432, *3 (July 27, 1990). [W]here services are rendered by one person for another, and are knowingly and voluntarily accepted, without more, the law presumes that such services were given and received in the expectation of being paid for and implies a promise to pay their reasonable worth. 66 American Jurisprudence 2d, Restitution and Implied Contracts, Section 40, at 695 (2011). Consequently, a physician or surgeon is entitled to recover from a patient, in the absence of an express agreement as to compensation, the reasonable worth of his or her services. Miami Valley Hosp. v. Middleton, 2d Dist. No. 24240, 2011-Ohio-5069, 20; Associated Physicians at *3; Neurosurgical Assoc., Inc. v. Borowsky, 8th Dist. No. 41197, 1980 WL 354911, *3 (Sept. 18, 1980); Sabroske v. Williamson, 79 Ohio Law Abs. 257, 257, 155 N.E.2d 286 (M.C.1958); Barman v. Feid, 27 Ohio N.P. (N.S.) 409, 413 (C.P.1929). In any civil action, a fundamental principle operates: He who affirms must prove. Hanna v. Groom, 10th Dist. No. 07AP-502, 2008-Ohio-765, 39. Thus, in an action to collect on a patients account, where there is no evidence of an agreement as to the fee for the services rendered, the burden is on the physician-plaintiff to prove their reasonable worth. Associated Physicians at *3; see also 42 Ohio Jurisprudence 3d, Evidence and Witnesses, Section 95, at 258 (2012) (plaintiff who seeks remuneration for the reasonable value of services rendered on the theory of an implied contract * * * has the burden of proving the reasonableness of the charges made for his or her services). The reasonable value of the services must be proven by competent, credible evidence presented at trial. Hailey v. MedCorp, Inc., 6th Dist. No. L-05- theory of recovery. Landskroner v. Landskroner, 154 Ohio App.3d 471, 2003-Ohio-4945, 12 (8th Dist.). Plaintiffs Complaint set forth the facts that establish its claim for relief; hence there is no infirmity in it.
  5. 5. 5 1238, 2006-Ohio-4804, 21, citing Gioffre v. Simakis, 72 Ohio App.3d 424, 428, 594 N.E.2d 1013 (10th Dist.1991). Plaintiffs evidence must establish the reasonable value of the services at the time and place they were rendered, by the person who rendered them. Middleton at 20; Neurosurgical Assoc. at *3; see also Bagley v. Bates, Wright 705, 706 (Ohio 1834) (reasonable value defined as that compensation usually paid for like services at the time and place when and where these were rendered). Reasonable value, therefore, must be determined in great measure by proof of what such services rendered by men of skill in their profession command at the place where they are rendered; that is, what sum in accordance with the usage and practice of those who render such service and those for whom they are rendered is asked and paid therefor. Saffin v. Thomas, 8 Ohio C.C. 253, 254-255, 4 Ohio Cir. Dec. 438 (Hamilton App.1894). B. In the Second District, a medical service provider is entitled to a presumption that its customary charge is reasonable. 1. Allocation of the burden of proof in this case is problematic because of the Second Districts ruling in Miami Valley Hosp. v. Middleton. If the foregoing were a complete statement of the applicable law, the allocation of the burden of proof in this case would be uncomplicated. Instead it is problematic. Despite the fact that, pursuant to longstanding precedent, the burden of proving the reasonableness of its charges would rest upon the Plaintiff, this Courts determination of the matter is foreclosed by Second District authority substantially relieving the Plaintiff of that burden. In Miami Valley Hosp. v. Middleton, 2d Dist. No. 24240, 2011-Ohio-5069, the Second District Court of Appeals ruled that in a collection action a hospital is entitled to the presumption that the reasonable value of its services is its customary charge. Middleton at 21. a. The case law and statute cited as authority in Middleton apply to personal