Plaintiffs accuse Ohio Department of Medicaid over improper fund collection

In a significant legal battle concerning Medicaid reimbursements, the Ohio Department of Medicaid faces allegations of improperly collecting funds from beneficiaries. The complaint was filed by Michael Pivonka and others in the Cuyahoga County Court of Common Pleas on April 5, 2013, against Scott Partika, Director of the Ohio Department of Medicaid. This case has been embroiled in legal proceedings for over a decade, raising questions about jurisdiction and equitable claims.

The origins of this case trace back to April 2013 when Michael Pivonka initiated a class-action lawsuit seeking equitable restitution from the Ohio Department of Job and Family Services (now under the purview of the Ohio Department of Medicaid). The plaintiffs alleged that Medicaid beneficiaries were compelled to repay money under an invalid subrogation statute, R.C. 5101.58. The plaintiffs argue that these repayments were collected without proper court orders between April 6, 2007, and April 5, 2013. Over time, party substitutions occurred with Paula Grady and Jessica Grady becoming named plaintiffs and Scott Partika as the defendant.

A pivotal moment came on December 21, 2017, when the trial court granted class certification to individuals who had repaid funds under the old recovery statute during the specified period. However, this decision faced multiple appeals. In a notable reversal by the Ohio Supreme Court in “Pivonka II,” it was determined that R.C. 5160.37 provided the sole remedy for such reimbursement claims post-September 29, 2007. This ruling questioned whether participants who repaid funds before this date could maintain their action without further jurisdictional fact development.

Subsequent amendments to complaints and motions for class certification ensued as Pivonka sought justice for those affected within the newly defined timeframe between April and September 2007. On November 29, 2023, another motion for class certification was granted by the trial court.

However, legislative changes introduced through House Bill 96 further complicated matters by amending R.C. 5160.37 to include an administrative review process applicable to repayments made between April and September 2007. This prompted additional legal scrutiny regarding subject-matter jurisdiction as ODM argued that this amendment divested courts of jurisdiction over such claims.

The current appeal centers around whether these legislative changes strip courts of their power to certify classes or grant relief in light of new statutory provisions effective September 30, 2025. The appellate court has remanded this issue back to lower courts for resolution while acknowledging unresolved assignments related to exclusive jurisdiction claims over state agency restitution demands and statute limitations on restitution actions.

Plaintiffs seek restitution for funds paid under duress without valid authority along with declaratory judgments affirming their rights against unlawful collections by state agencies like ODM.

Representing appellees are attorneys Patrick J. Perotti from Dworken & Bernstein Co., L.P.A., James A. DeRoche from Garson Johnson LLC; Christian R Patno from McCarthy Lebit Crystal & Liffman Co., LPA; whereas Dave Yost serves as Ohio Attorney General alongside Assistant Attorneys General Henry G Appel & Caitlyn N Johnson representing appellant interests before Judges Deena R Calabrese Michelle J Sheehan Sean C Gallagher overseeing Case No CV-13-804235 at Eighth Appellate District County Cuyahoga Courts