Case Title: Hoover vs. Mercy Health

Citation: 

Docket Number: SC92788

State: missouri

Court: Missouri Supreme Court

Date: 2013-09-10T00:00:00Z

Document:
SUPREME COURT OF MISSOURI 
en banc  
Richard Hoover, Individually, and as 
 
) 
Class Representative, 
 
 
 
) 
 
 
 
 
Appellant, 
 
) 
 
 
 
 
 
 
 
) 
vs. 
 
 
 
 
 
 
) 
No. SC92788 
 
 
 
 
 
 
 
) 
Mercy Health d/b/a Mercy Health System; 
) 
Mercy Hospitals East Communities, d/b/a 
) 
St. John's Mercy Medical Center and/or  
) 
St. John's Mercy Health System; and  
 
) 
St. John's Mercy Medical Center, d/b/a   
) 
Mercy Hospitals East Communities and/or 
) 
St. John’s Mercy Health System,  
 
) 
 
 
 
 
 
 
 
) 
 
 
 
 
Respondents.  
) 
 
 
Appeal from the Circuit Court of St. Louis County  
The Honorable James R. Hartenbach, Judge 
 
Opinion issued September 10, 2013 
 
PER CURIAM 
 
Richard Hoover appeals from a judgment dismissing his individual and class 
action lawsuit against the defendant corporations, which own, operate or do business as 
St. John's Mercy Medical Center (collectively "Mercy").  Hoover asserts that the trial 
court erred in dismissing his petition because it sufficiently states a cause of action.  The 
judgment is reversed, and the case is remanded. 
 
 
I. Facts and Procedure 
 
In March 2009, Hoover underwent surgery at Mercy.  Mercy billed Hoover 
$17,337.39 for the medical goods and services provided.  Hoover paid $5,300, but 
otherwise disputed the bill.  Mercy referred the matter to a collection agency.  Hoover 
then filed suit against Mercy alleging that Mercy falsely and fraudulently charged him for 
goods and services relating to the surgery.  Mercy filed a motion to dismiss asserting that 
Hoover sued the wrong party and failed to state a claim.  Hoover filed a memorandum in 
opposition to Mercy's motion in which he acknowledged the contract and provided copies 
of original hospital bills and correspondence with Mercy's collection agency. 
 
Hoover filed an amended petition adding Mercy Health and Mercy Hospitals East 
Communities as defendants and alleging that they owned, operated, and did business as 
St. John's Mercy Medical Center.  He further alleged that all of the defendants were part 
of the St. John's Mercy Health System and acted as agents of one another.  
 
Mercy filed a motion to dismiss Hoover's amended petition for failure to state a 
claim.  Mercy argued that Hoover suffered no damages because he had not paid the full 
amount of the bill.  Mercy also attached to the motion a copy of a contract dated March 
10, 2009, signed by Hoover as the patient, and titled "Release of Information, 
Assignment of Benefits, and Financial Responsibility."  Finally, Mercy attached a 
newspaper article and a document titled "NCO Financial Systems, Inc.--Midwest Debtor 
Notes" that listed actions on Hoover's account from November 2009 through August 
2011 and showed a $1,000 payment on June 17, 2011, and a $4,300 payment on         
June 24, 2011.  Hoover did not file a new memorandum in opposition to the motion to 
dismiss the amended petition.  
 
The trial court entered a judgment sustaining Mercy's motion to dismiss.  Hoover 
appeals. 
II. Standard of Review 
 
Hoover and Mercy dispute the applicable standard of review.  Hoover asserts that 
this appeal is governed by the standards applicable to review of a judgment sustaining a 
motion to dismiss.  Mercy contends that Hoover's motion to dismiss should be treated as 
a motion for summary judgment pursuant to Rule 55.27(a) because the trial court 
considered Hoover's contract, billing records and other factual matters outside the 
pleadings.   
 
Rule 55.27(a) provides: 
If, on a motion asserting the defense numbered (6) to dismiss for 
failure of the pleading to state a claim upon which relief can be 
granted, matters outside the pleadings are presented to and not 
excluded by the court, the motion shall be treated as one for summary 
judgment and disposed of as provided in Rule 74.04.  All parties shall 
be given reasonable opportunity to present all materials made 
pertinent to such a motion by Rule 74.04.   
 
Therefore, Rule 55.27(a) allows a trial court to treat a motion to dismiss as a motion for 
summary judgment if: (1) matters outside the pleadings are presented and not excluded 
by the trial court and (2) the parties are given a "reasonable opportunity" to present a 
summary judgment record as set forth in Rule 74.04.  
 
Hoover's response to Mercy's motion to dismiss included hospital bills and 
correspondence with Mercy’s collection agency.  Mercy's motion to dismiss Hoover's 
 
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amended petition included records of Hoover's medical care, the contract, billing records, 
and a newspaper article.  Thus, the parties submitted "matters outside the pleadings."  
This Court will not presume that the trial court excluded or considered the matters 
presented outside the pleadings without reference to the trial court's ruling on the motion.   
 
 "Before a trial court may treat a motion to dismiss as one for summary judgment, 
when matters outside the pleadings are presented and not excluded, it must notify the 
parties that it is going to do so and give the parties an opportunity to present all materials 
pertinent to the motion for summary judgment."  Turner Engineering, Inc. v. 1491155 
Weldon Parkway, L.L.C., 40 S.W.3d 406, 408 (Mo. App. 2001) (citing Rule 55.27(a); 
Manzer v. Sanchez, 985 S.W.2d 936, 939 (Mo. App. 1999)).   
 
The record in this case gives no indication that the parties and the trial court 
treated Hoover's motion to dismiss as a summary judgment proceeding.  The judgment 
entered states only that: 
Defendants' Motion to Dismiss heretofore called, argued and 
submitted is hereby sustained.  Costs taxed against Plaintiff. 
 
Therefore, not only is there nothing in the record to suggest that the trial court notified 
the parties it would be treating the motion to dismiss as a motion for summary judgment 
pursuant to Rule 55.27(a), but the face of the judgment also demonstrates that the trial 
court did not do so. 
 
The trial court's declaration that it was granting the defendants' motion to dismiss 
stands as an affirmative statement that the trial court did not consider any facts outside 
 
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the pleadings or decide any questions such facts might present.  Accordingly, this Court 
is bound by that statement and may review only that decision.   
III. Claim Adequately Pleaded 
Hoover's amended petition states a viable claim for breach of contract.  Hoover 
alleges that Mercy double-billed him, i.e., billed him for goods and services for which he 
already had paid.  In addition, Hoover alleges that the hospital engaged in "upcoding" in 
assembling his bill.1  Hoover had no obligation to pay twice and no obligation to pay for 
goods or services that he did not receive.  Accordingly, Hoover's amended petition states 
a claim for breach of contract2 and should not have been dismissed. 
Having determined that the petition states a claim, it is unnecessary to decide what 
other theories can be supported by the facts pleaded by Hoover.  The trial court will be in 
the best position to consider such matters as the case progresses and whether further 
amendments to the petition to raise other claims should be permitted.   
IV. Conclusion 
The judgment is reversed, and the case is remanded. 
 
All concur.   
 
1   Hospital bills are prepared using standard codes for the various goods and services, and the 
term "upcoding" refers to the "practice of billing … for medical services or equipment 
designated under a code that is more expensive than what a patient actually needed or was 
provided."  United States ex rel. Bledsoe v. Cmty. Health Sys., Inc., 342 F.3d 634, 638 (6th Cir. 
2003) (citing Bonnie Schreiber, et al., Health Care Fraud, 39 Am.Crim. L.Rev. 707, 750 n.331 
(2002)). 
2   Such claims typically arise as a defense to an effort by the other party to the contract to collect 
more than it is owed.  However, there is no reason why Hoover cannot raise this claim 
offensively either to recover damages (if any) or in pursuit of a declaratory judgment over what 
is rightfully owed.