Bethesda Hospital v. Kessnick (In re Kessnick)

178 B.R. 150, 1993 Bankr. LEXIS 2245
CourtUnited States Bankruptcy Court, S.D. Ohio
DecidedDecember 9, 1993
DocketBankruptcy No. 93-11212; Adv. No. 93-1068
StatusPublished

This text of 178 B.R. 150 (Bethesda Hospital v. Kessnick (In re Kessnick)) is published on Counsel Stack Legal Research, covering United States Bankruptcy Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bethesda Hospital v. Kessnick (In re Kessnick), 178 B.R. 150, 1993 Bankr. LEXIS 2245 (Ohio 1993).

Opinion

JUDGMENT ENTRY

J. VINCENT AUG, Jr., Bankruptcy Judge.

This adversary proceeding is before the Court pursuant to a complaint filed by Bethesda Hospital under 11 U.S.C. § 523(a)(2), (a)(4) and (a)(6). The complaint alleges that certain payments made to the Debtor by Community Mutual Insurance Company belonged to Bethesda Hospital (“the hospital”) and that the debtor intentionally defrauded the hospital by using the money for his own purposes rather than turning the money over to the hospital as required by the Claim Payment Authorization the Debtor signed when he admitted his daughter for hospitalization.

The Court has jurisdiction over this matter pursuant to 28 U.S.C. §§ 157 and 1334. This is a core proceeding pursuant to 28 U.S.C. § 157(b)(2).

A trial was conducted on November 2, 1993. At the conclusion of the trial, the Court issued a conditional opinion from the bench (copy of transcript attached) in which it stated that while it believed the hospital had made out a case for nondisehargeability, its decision was subject to change depending on what was shown when the plaintiff hospital submitted as evidence a copy of the Explanation of Benefits that had been sent to Mr. Kessnick along with the errant check. The Court was of the belief that since Mr. Kessnick had testified that he thought the check was his and was issued to him to reimburse him for certain medical services provided as a result of a shoulder injury, the submission of the Explanation of Benefits would help clarify his intent upon receipt of the check. It was believed by hospital witnesses that the Explanation of Benefits would identify clearly at first glance the name of the patient on whose behalf the check was issued.

The record was held open for submission of the Explanation of Benefits form and on November 3, 1993, the Court received a letter from plaintiff’s counsel enclosing “two exemplars of the Explanation of Benefits forms” that are sent out by Community Mutual when it issues a cheek. The letter informed the Court that the actual forms mailed to Mr. Kessnick could not be recreated. The forms enclosed as exemplars indicated that in the upper left hand corner was a line with the word “Customer.” The representative from Community Mutual indicated that Mr. Kessnick’s name would appear after this line. The salutation on the form would have read “Dear Mr. Kessnick.” Below the salutation was the sentence “This is a general explanation of the claims processed by Community Mutual Blue Cross and Blue Shield.” Underneath this line were a number of categories, the first of which contained the heading “Patient Name.” It was under this heading that the name of Mr. Kessnick’s daughter, Joanna Kessnick, would have appeared. The patient’s name did not appear prominently at the top of the form as the Court assumed it would.

[152]*152Given that one gross error in the calculation of Joanna Kessnick’s bill was admitted by the plaintiff, that the plaintiff further acknowledged that it has had a problem for years in receiving direct payments of major medical benefits from insurance companies where there has been an Assignment of Claim, and that the Explanation of Benefits form tendered as evidence did not prominently display the name of the patient, we hold that Bethesda Hospital has not met its burden of proof by a preponderance of the evidence. While we acknowledge that this may have been a close case, we believe a finding of fraudulent intent would be inappropriate given the minimal evidence presented on that issue. Further, we agree with Mr. Kessnick’s counsel that there has been no showing under § 523(a)(2) of actual fraud or of the use of a false financial statement, nor has there been a showing of fraud or embezzlement in a fiduciary capacity as required under § 523(a)(4).

Accordingly, the debt of Richard Kessnick to Bethesda Hospital in the amount of $6,175 arising from the hospitalization of Mr. Kess-nick’s daughter Joanna, is hereby DISCHARGED.

IT IS SO ORDERED.

APPENDIX

UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF OHIO WESTERN DIVISION

Bethesda Hospital, Plaintiff, v. Ronald Kessnick, Defendant.

COURT’S RULING

Case No. 93-1068

APPEARANCES

On behalf of Plaintiff:

EDWARD NOE, ESQ.

Immerman & Tobin Co., L.P.A.

910 Atlas Bank Bldg.

524 Walnut Street

Cincinnati, Ohio 45202

On behalf of Defendant:

JOHN ROSE, ESQ.

711 Provident Bank Bldg.

632 Vine Street

BE IT REMEMBERED that the above-entitled hearing came on to be heard before the Honorable Vincent Aug on the 2nd day of November, 1993.

TRI-COUNTY REPORTING AND VIDEOTAPE SERVICE 95 S. FOURTH STREET BATAVIA, OH 45103 (513) 732-1477

THE COURT: All right. Well, you know, this is a difficult case. Let me ask one question about evidence. I know we’ve talked about this but I’m not certain that it is in evidence. Is the explanation of benefits a matter of record in this case?

MR. NOE: No, it is not.

THE COURT: That was attached to the check?

MR. NOE: No.

THE COURT: Does anyone wish to place it in evidence or can it be?

MR. NOE: If I could get a copy, it can be reproduced, Your Honor.

THE COURT: Well, the reason I ask is that I’m personally familiar with the structure of those documents simply because I happen to have the same insurance carrier. I’m also familiar with the difficulties in understanding them that some laymen have but I don’t want my knowledge of what that looks like to be evidence in this case and I think—

MR. NOE: Your Honor, I would certainly like to submit it. Had I been able to obtain that from Blue Cross & Blue Shield, I certainly would have submitted it. I was not [153]*153able to. They told me that it could be reproduced and—

THE COURT: Yeah. Well, I would like to place it in evidence and the reason is that my experience which, unfortunately, is rather extensive with those documents, tells me that regardless of the difficulties in understanding the numbers, that very clearly at the top of those documents, it describes who the patient is up on the right hand side. -That’s my experience. Now, if you have trouble missing who the patient is, you may have trouble understanding what happened and what was covered and what wasn’t covered but it’s very easy to see what it’s about and I hate to say that my knowledge about that is affecting my decision here and I believe that should be made a matter of record.

MR. NOE: I will advise the Court.

THE COURT: Having said that, though, I have an opinion in this matter and the opinion can change from the explanation of benefits can’t be produced and can’t be put into evidence but I believe in this case that the hospital has made out a case here for non-dischargability.

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Related

Exceptions to discharge
11 U.S.C. § 523(a)(2)
Procedures
28 U.S.C. § 157
§ 1334
28 U.S.C. § 1334

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Bluebook (online)
178 B.R. 150, 1993 Bankr. LEXIS 2245, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bethesda-hospital-v-kessnick-in-re-kessnick-ohsb-1993.