Daily Case Update Archive

As a service to our members, we monitor opinions issued from the Ohio Supreme Court, the Ohio State First District Court of Appeals, and the United States Sixth Circuit Court of Appeals.  You can read the latest summaries or archived summaries from 2005 or 2006.

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March 21, 2006

Ohio Supreme Court | Ohio First District | U.S. 6th Circuit - Ohio | U.S. 6th Circuit - Other States
 

TOPICS:
- Insurance: benefits denial, standard of review
- Medicaid:  definition of medical devices, "freedom of choice", private right to sue
 

Ohio Supreme Court

 

No Opinion.
 

First District Court of Appeals

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No Opinion.
 

U.S. Sixth Circuit Court of Appeals:  Ohio Cases

 

University Hosp. of Cleveland v. South Lorain Merchants Ass'n Health & Welfare Benefit Plan & Trust (March 21, 2006) (Appeal from N.D. Ohio)
- http://www.ca6.uscourts.gov/opinions.pdf/06a0105p-06.pdf
- A patient covered by the Merchants Ass'n health plan received benefits from the University Hospitals.  The patient's father assigned insurance rights and benefits to the hospital.  The hospital billed the plan administrator for nearly $200,000 in services.  The administrator deducted a $48,000 discount, and then had the bill audited.  An additional $40,000 was deducted based on the audit, which indicated those services were excessive.  University Hospital appealed partial denial of benefits, which led to a discovery that the discount was incorrect and the Association remedied that discrepancy.  The hospital sued the association in district court, which, after remanding the case back to the plan administrator for further fact finding, found in the hospital's favor for $74,000.  The association appealed.  REVERSED, because proper standard of review of denial of plan benefits was "abuse of discretion", not "de novo", and REMANDED.
 

U.S. Sixth Circuit Court of Appeals: Other States Cases

 

Harris v. Olszewski (March 21, 2006) (Appeal from E.D. Mich.)
-  http://www.ca6.uscourts.gov/opinions.pdf/06a0104p-06.pdf
-  Plaintiffs sued, as a class, the Michigan Department of Community Health under 42 USC § 1983, which was enforcing a single supplier contract for all Michigan Medicaid recipients using incontinence products.  The district court granted summary judgment to the plaintiffs, and the agency appealed.  REVERSED and REMANDED, because although Medicaid's "freedom of choice" provision creates a private right enforceable by §1983, the term "medical devices" was ambiguous and the agency's interpretation did not deserve deference.
 

Daily Case Updates