Centron Services v. Perucca ( 2004 )

No. 03-583
IN THE SUPREME COURT OF THE STATE OF MONTANA
2004 MT 270N
CENTRON SERVICES, INC.,
Plaintiff and Respondent,
v.
ALBERT J. PERUCCA,
Defendant and Appellant.
APPEAL FROM: District Court of the Eighth Judicial District,
In and for the County of Cascade, Cause No. ADV 2002-533,
The Honorable Thomas M. McKittrick, Judge presiding.
COUNSEL OF RECORD:
For Appellant:
Albert J. Perucca (pro se), Great Falls, Montana
For Respondent:
David Hull, Attorney at Law, Helena, Montana
Submitted on Briefs: January 21, 2004
Decided: September 28, 2004
Filed:
__________________________________________
Clerk
Justice John Warner delivered the Opinion of the Court.
¶1 We have determined to decide this case according to Section I, Paragraph 3(d)(i),
Montana Supreme Court Internal Operating Rules, as amended in 2003, which provides for
memorandum opinions. Pursuant to Section I, Paragraph 3(d)(v), Montana Supreme Court
1996 Internal Operating Rules, as amended in 2003, the following decision shall not be cited
as precedent. Its case title, Supreme Court cause number and disposition shall be included
in this Court’s quarterly list published in the Pacific Reporter and Montana Reports.
¶2 Albert J. Perucca (Perucca), appearing pro se, appeals from the judgment and order
of the Eighth Judicial District Court, Cascade County, granting summary judgment in favor
of Centron Services, Inc. (Centron). The District Court concluded that physicians are not
precluded from charging the general public (non-Medicaid patients) a usual and customary
fee even though the charge may be higher than the Medicaid rate. The District Court also
concluded there were no issues of material fact with regards to the services provided to
Perucca, the amount charged for the services, the insurance payments credited, or the
balance owed by Perucca. We affirm.
¶3 The issue on appeal is whether the District Court erred when it concluded the federal
Medicaid laws do not preclude physicians from charging non-Medicaid patients the usual
and customary charge. Perucca received medical services from the Great Falls Clinic (the
Clinic) as a non-Medicaid, non-Medicare patient, who had insurance through Conseco
Medical Insurance. The Clinic billed Perucca its usual and customary charge for services
rendered. All offsets, credits, discounts and insurance payments were credited to the
account. The Clinic sent Perucca monthly billing statements from June 5, 1999, through
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September 7, 2000, but received no response or payment from Perucca. The Clinic assigned
the account to Centron for collection. Centron then filed suit against Perucca in Justice
Court to collect on the account. Judgment was granted to Perucca in Justice Court and
Centron filed an appeal in District Court.
¶4 On appeal, Perucca asserts that under his reading of the federal Medicaid laws, the
Clinic was required to charge him, a member of the general public, the same amount for
medical services as it would have charged a Medicaid patient for the same services. We
disagree.
¶5 There is no legal support for Perucca’s theory that the general public may not be
charged more than the Medicaid rates. Pursuant to the Medicaid Act, Title XIX of the Social
Security Act, 42 U.S.C. § 1396 et. seq., the federal government is authorized to reimburse
states who provide medical assistance to eligible low income persons. Participation in the
program is voluntary; however, if a state elects to participate, the state must comply with all
federal statutory and regulatory mandates. One such regulation provides for the exclusion
of providers who attempt to charge the Medicaid program more than the provider’s usual and
customary charge to the general public. See 42 C.F.R. § 1001.701(a)(1). The purpose of
this Medicaid regulation is to prevent providers from submitting bills to the government
which are substantially in excess of their usual and customary charges unless there is good
cause. 42 C.F.R. § 1001.701(c)(1). The purpose of the regulations, is not, as Perucca
asserts, to require physicians to charge the general public the same amount as it would
charge Medicaid patients for the same services.
¶6 Accordingly, the Clinic was not required under federal Medicaid laws to charge
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Perucca, a non-Medicaid patient, at the Medicaid rate. The Clinic properly billed Perucca
for the specific services rendered. Because Perucca failed to make any payments on the
account, the Clinic assigned the account to Centron for collection. Centron then filed suit
in order to collect the debt owing from Perucca. Centron is entitled to payment as assignee
of Perucca’s account.
¶7 On the face of the briefs and the record before us on appeal, it is manifest that the
appeal is without merit because the District Court correctly interpreted legal issues clearly
controlled by established law. The record establishes that there are no material facts at issue.
The issue regarding the Fair Debt Collection Practices Act, which Perucca attempts to raise
on appeal, was neither pled nor raised in the District Court. It is not properly before us on
appeal.
¶8 Affirmed.
/S/ JOHN WARNER
We Concur:
/S/ KARLA M. GRAY
/S/ JIM RICE
/S/ JAMES C. NELSON
/S/ JIM REGNIER
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