Farm Bureau General Insurance Co v. Maple Manor Neuro Center Inc

CourtMichigan Court of Appeals
DecidedNovember 16, 2023
Docket362824
StatusUnpublished

This text of Farm Bureau General Insurance Co v. Maple Manor Neuro Center Inc (Farm Bureau General Insurance Co v. Maple Manor Neuro Center Inc) is published on Counsel Stack Legal Research, covering Michigan Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Farm Bureau General Insurance Co v. Maple Manor Neuro Center Inc, (Mich. Ct. App. 2023).

Opinion

If this opinion indicates that it is “FOR PUBLICATION,” it is subject to revision until final publication in the Michigan Appeals Reports.

STATE OF MICHIGAN

COURT OF APPEALS

FARM BUREAU GENERAL INSURANCE UNPUBLISHED COMPANY, November 16, 2023

Plaintiff-Appellee,

v No. 362824 Oakland Circuit Court MAPLE MANOR NEURO CENTER, INC., LC No. 2020-184709-NZ

Defendant-Appellant.

Before: RIORDAN, P.J., and CAVANAGH and GARRETT, JJ.

PER CURIAM.

In this no-fault case, defendant appeals as of right the order granting summary disposition under MCR 2.116(C)(10) (no genuine issue of material fact) to plaintiff, in an action to recover fees paid for medical care provided to plaintiff’s insured. On appeal, defendant contends the trial court erred in granting summary disposition on an unpled theory of unjust enrichment, and that a genuine issue of fact remains regarding whether defendant committed fraud. We reverse and remand for proceedings consistent with this opinion.

I. BACKGROUND FACTS AND PROCEDURAL HISTORY

This case arises out of injuries sustained by Veronica Fuentez-Noguez in a motor vehicle accident. At the time of the accident, Fuentez-Noguez (the insured) was insured under a policy of automobile insurance with plaintiff. The insured was admitted to a licensed 72-bed nursing home known as Maple Manor Rehab Center of Novi (Maple Manor Rehab) in February of 2017, where she stayed until December of 2017.

Claim forms for the insured’s care submitted to plaintiff gave defendant’s name as both the “billing provider” and in a field for “signature of physician or supplier including degrees or credentials.” In the field for “service facility location information,” the forms include the name of “Maple Manor Novi.” Maple Manor Rehab and defendant are owned by Dr. Jose Evangelista and Dr. Stella Evangelista. Plaintiff paid $367,619.04 to defendant for the insured’s care.

-1- In 2019, the Michigan Department of Licensing and Regulatory Affairs (LARA) completed a licensure survey of Maple Manor Rehab facility. LARA found Maple Manor Rehab to be “in substantial compliance,” but reported the following noncompliance: The facility was providing formal nursing care services, including mechanical ventilation and tracheostomy care, to seven residents in their “Neuro” wing without first obtaining a license for the beds in that unit.

In 2020, Maple Manor Rehab applied to “replace and relocate 9 existing licensed nursing home beds within the same building.” Identified to receive one of the transferred licenses was bed 122- 1, the bed to which plaintiff was admitted.

Plaintiff filed this complaint on November 17, 2020, alleging that defendant provided the insured’s care and billed plaintiff for services “as an adult foster care center or nursing home,” while lacking licensure to operate in that capacity. Plaintiff asserted a claim under MCL 500.31571 of the no-fault act, MCL 500.3101 et seq. Before June 10, 2019, MCL 500.3157 of the no-fault act stated, in pertinent part: “A physician, hospital, clinic or other person or institution lawfully rendering treatment to an injured person for an accidental bodily injury covered by personal protection insurance . . . may charge a reasonable amount for the products, services and accommodations rendered.” MCL 500.3157. Accordingly, plaintiff alleged that because defendant was not licensed as a nursing home or adult care center, the services it provided were not lawfully rendered, and not compensable, entitling plaintiff to reimbursement of payments made to defendant. Plaintiff asserted an additional claim for “fraud/innocent misrepresentation/silent fraud.” Defendant’s answer denied providing the insured’s care, and insisted it operated as “merely a billing agent that submitted medical bills . . . on behalf of a licensed medical service provider Maple Manor Rehab Center of Novi Inc.”

Plaintiff moved for summary disposition under MCR 2.116(C)(10), arguing that because defendant was not licensed to perform adult foster care and nursing care, defendant’s billing for the insured’s care was in contravention of MCL 500.3157. Plaintiff also argued that because the insured was not treated in a licensed nursing home bed, her treatment was unlawfully rendered and plaintiff was not obligated to pay, under MCL 500.3157. Finally, plaintiff argued that defendant’s presentation of medical bills for the insured’s care defrauded plaintiff.

Having dispensed with oral argument, the trial court issued an opinion and order granting plaintiff summary disposition. First, the trial court found that defendant wrongfully billed plaintiff for adult foster care and nursing home care. The trial court rejected defendant’s argument that it was a billing agent for Maple Manor Rehab in 2017. The trial court found that, because defendant did not lawfully render treatment, it did not have a right to charge for and receive payment for the services. The trial court continued:

1 MCL 500.3157 was amended, effective June 11, 2019. 2019 PA 21. We consistently cite MCL 500.3157 as it read before the 2019 amendment, because the insured’s treatment took place in 2017.

-2- Farm Bureau is entitled to recoup the payments for the nursing home care under a theory of unjust enrichment. The elements of unjust enrichment are: “(l) the receipt of a benefit by defendant from plaintiff, and (2) an inequity resulting to plaintiff because of the retention of the benefit by defendant.” Belle Isle Grill Corp v City of Detroit, 256 Mich App 463, 478; 666 NW2d 271 (2003). When such elements exist, “the law operates to imply a contract in order to prevent unjust enrichment.” Barber v SMH (US), Inc, 202 Mich App 366, 375; 509 NW2d 791 (1993). Here, Neuro has received a benefit in the form of payment of $215,230 for nursing home care, and it would be inequitable for Neuro to retain that benefit. Therefore, Farm Bureau is entitled to recoup that amount from Neuro.

Second, the trial court found that the insured was not treated in a licensed nursing home bed, which defendant did not present any evidence to dispute. The trial court concluded: [E]ven if the Court finds there is a question of fact as to whether Neuro’s lack of licensure as a nursing home rendered the treatment unlawful for purposes of MCL 500.3157, the fact that Claimant was, in fact, treated in an unlicensed nursing home bed would still render the treatment unlawfully rendered.

The trial court further concluded that defendant’s presentation of medical bills to plaintiff constituted fraud, justifying summary disposition for plaintiff. Even viewing the evidence in the light most favorable to Neuro, there is no genuine issue of fact for trial and Farm Bureau is entitled to judgment as a matter of law. Neuro’s failure to disclose that it was not licensed to provide nursing care and its failure to disclose that the bed in which Claimant was treated was not licensed to a nursing home bed were material omissions, and Farm Bureau reasonably relied on the omissions when it issued payment to Neuro. Farm Bureau was not obligated to investigate Neuro’s licensure.

This appeal followed.

II. STANDARD OF REVIEW

We review summary disposition rulings de novo. Grossman v Brown, 470 Mich 593, 598; 685 NW2d 198 (2004). This Court reviews a motion for summary disposition on appeal in the same way the trial court was obligated to review it. See Bronson Methodist Hosp v Auto-Owners Ins Co, 295 Mich App 431, 440; 814 NW2d 670 (2012).

Summary disposition under MCR 2.116(C)(10) is warranted when “[e]xcept as to the amount of damages, there is no genuine issue as to any material fact, and the moving party is entitled to judgment or partial judgment as a matter of law.” MCR 2.116(C)(10).

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Farm Bureau General Insurance Co v. Maple Manor Neuro Center Inc, Counsel Stack Legal Research, https://law.counselstack.com/opinion/farm-bureau-general-insurance-co-v-maple-manor-neuro-center-inc-michctapp-2023.