Michigan Court of Appeals; Docket No. 138159; Published
Judges Wahls, Reilly, and R. M. Daniels; Unanimous; Per Curiam
Official Michigan Reporter Citation: 204 Mich App 142; Link to Opinion 
STATUTORY INDEXING:
Standards for Deductibility of State and Federal Governmental Benefits [§3109(1)]
Medicaid Benefits [§3109(1)]
General / Miscellaneous[§3171]
TOPICAL INDEXING:
Medicaid Benefits
CASE SUMMARY:
In this unanimous per curiam published Opinion, the Court of Appeals held that Citizens Insurance Company was responsible for paying all of plaintiff’s reasonable medical expenses incurred during hospitalization at Children's Hospital, even though the Michigan Department of Social Services had mistakenly determined that plaintiff was entitled to Medicaid benefits for part of those medical expenses.
Plaintiff was injured while walking across a highway and struck by an automobile. There was no automobile insurance in the family, and no other automobile insurance was available to plaintiff, and therefore, plaintiff’s claim was assigned to Citizens under the assigned claims plan, §3171.
Plaintiff was hospitalized twice, and Citizens paid the full amount of the bill for the first hospitalization. However, the bill for the second hospitalization amounting to $145,941 was paid in part by Michigan Department of Social Services on the mistaken belief that plaintiff was entitled to Medicaid benefits. DSS therefore paid Children's Hospital $62,497 out of the total expenses incurred. DSS was reimbursed this same amount from Citizens, leaving an unpaid amount of $83,444.
Citizens refused to pay the remainder of the medical bill to either plaintiff or the hospital, contending that payment of Medicaid benefits on behalf of plaintiff totally discharged her and her family from any further responsibility for payment for medical treatment rendered by Children's Hospital. Citizens contended that if plaintiff cannot be held responsible for the remainder, Citizens cannot be obligated to pay that amount.
In reversing the trial court determination in favor of Citizens, the Court of Appeals held that the fact that Medicaid benefits were mistakenly paid on plaintiffs behalf does not release plaintiff’s responsibility for those medical expenses incurred, nor does it bind the hospital to limit its claim to the statutory amount allowed for Medicaid benefits. Botsford General Hospital v Citizens Insurance Company, 195 Mich App 127 (1992). The court held that any agreement between Children's and the DSS to make or accept payments in violation of the law is not enforceable. The court held that Citizens is obligated to pay PIP benefits to or on behalf of the plaintiff, including reasonable and customary medical expenses. Therefore, the trial court was reversed.
