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Melnyk v. Ohio Department of Medicaid

Court of Appeals of Ohio, Tenth District

December 12, 2019

Melinda Melnyk, Plaintiff-Appellant,
v.
Ohio Department of Medicaid, Defendant-Appellee.

          APPEAL from the Franklin County Court of Common Pleas C.P.C. No. 17CV-6227)

         On brief:

          Friedman, Domiano & Smith Co., L.PA., Jeffrey H. Friedman, and Richard L. Warren, Jr., for appellant.

          Dave Yost, Attorney General, and Theresa R. Dirisamer, for appellee.

         Argued:

          Richard L. Warren, Jr.

          Theresa R. Dirisamer.

          DECISION

          DORRIAN, J.

         {¶ 1} Plaintiff-appellant, Melinda Melnyk, appeals the August 16, 2018 decision and entry of the Franklin County Court of Common Pleas affirming the June 30, 2017 decision of defendant-appellee, Ohio Department of Medicaid ("ODM"). For the following reasons, we affirm.

         I. Facts and Procedural History

         {¶ 2} This matter arises out of an accident on July 13, 2011, as a result of which appellant, a Medicaid recipient, suffered serious injuries. On October 19, 2011, counsel for appellant sent a letter to ODM[1] seeking an itemization of Medicaid expenditures advanced on appellant's behalf. In the letter, counsel for appellant stated that "[t]his letter shall serve as an acknowledgment of [ODM's] purported interest in the case, and [ODM's] purported interest will be protected to the extent [ODM] is entitled to relief under the contract as interpreted by Ohio law." (Oct. 19, 2011 Letter at 1.)

         {¶ 3} On November 18, 2011, ODM sent appellant a letter stating that "[p]ursuant to [R.C.] 5101.58 and 5101.59, [ODM] has an automatic right of recovery against the liability of a third party for the cost of medical services and care arising out of injury, disease, or disability of the Medicaid recipient." On February 3, 2012, ODM sent appellant a letter informing her the interim amount of medical expenditures to date totaled $126, 568.93 and stating "[ODM] must be reimbursed for its medical assistance if a judgment or settlement is reached."

         {¶ 4} On April 11, 2012, ODM sent appellant a letter in which it again stated "[ODM] must be reimbursed for its medical assistance if a judgment or settlement is reached." ODM also informed appellant that the final amount of medical expenditures owed was $126, 568.93. Attached to the April 11, 2012 letter was an ODM request for reduction form that contained the following statements: "[ODM] requires full payment of related medical assistance paid unless the settlement is not sufficient to permit full payment. The following information is needed in order for a request for reduction to be considered. Completion of this form does not guarantee that your request will be approved. [ODM] makes the final decision in all reduction requests."

         {¶ 5} On June 7, 2012, [2] appellant's counsel sent ODM a letter seeking to "discuss settlement of [ODM's] lien." Attached to the June 7, 2012 letter was the request for reduction form, which had been filled with information detailing the nature of appellant's request for the reduction of the claim. The letter explains that appellant only received $300, 000 as settlement from the parties involved in her accident and that appellant's counsel "spent numerous hours deposing both drivers and speaking with witnesses" to prove negligence. (Rec. of Proceedings at 62.) The letter further explained appellant is a single mother of two minor children and that the amputation of her left leg has hindered her ability to care for them. Finally, the letter explains she has been assessed substantial charges to hire drivers and housekeepers, and as a result it is necessary for her to recover as much as possible from this settlement. In the form, which was signed and dated June 7, 2012, appellant's counsel listed appellant's settlements in the amount of $300, 000.00, attorney fees in the amount of $120, 000.00, and expenses in the amount of $17, 227.93. Appellant's counsel requested the state reduce its recovery to $50, 000.00, leaving a remainder from the settlements in the amount of $112, 772.07 for appellant. Attached to the form was a breakdown of settlement, attorney fees, and expenses.

         {¶ 6} On June 19, 2012, ODM sent appellant a letter agreeing to reduce the amount appellant owed to satisfy recovery of medical expenditures to $77, 848.03. In the letter, ODM stated the following: "[ODM] must be reimbursed for these Medicaid expenditures if a settlement is reached. The amount of the medical expenditures to date is $126, 568.93. However, [ODM] has agreed to reduce the portion of the medicals owed to the State to $77, 848.03." On July 30, 2012, ODM sent appellant a letter acknowledging appellant's payment of $77, 848.03 and discharging her from liability.

         {¶ 7} On March 11, 2016, following amendments to Ohio's statutes governing ODM's recovery rights for the costs of medical assistance, appellant sent a letter to ODM requesting a hearing to contest the amount of repayment. On April 22, 2016, ODM acknowledged ...


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