Smallwood v. Central Peninsula General Hospital

OPINION

EASTAUGH, Justice.

I. INTRODUCTION

The main question here is whether John L. Smallwood, a Medicaid recipient treated at Central Peninsula General Hospital, can sue the hospital to enforce Medicaid billing standards, particularly the “balance billing” prohibition that prevents billing for amounts (apart from authorized copayments) exceeding those reimbursable under Medicaid. We conclude that Smallwood is a third-party beneficiary of the provider agreement between the hospital and the state; he can therefore sue to enforce the balance billing prohibition. We also conclude that he has a…