Kolbe & Kolbe Health and Welfare Benefit Plan v. Medical College of Wisconsin, Inc.

Dist. Ct. did not err in granting defendant-hospital’s motion for summary judgment in plaintiff-health plan’s breach of contract action seeking refund of $1.7 million that plaintiff had paid defendant for medical services provided to child of plaintiff’s beneficiary, where plaintiff determined 11 months after child began medical treatment that child was not covered under plaintiff’s health plan. While plaintiff argued that it was entitled to refund, subject contract did not contain any language calling for refunds, and plaintiff failed to present evidence that defendant had not provided medical services at issue in $1.7 million medical bill. Moreover, Ct. rejected plaintiff’s contention that contract contained implicit term requiring refund and noted that plaintiff could not seek recovery here, where plaintiff was entity that had made relevant mistake by paying medical bills prior to making determination that child was not covered under health plan. Fact that defendant had sporadically provided refunds to plaintiff or other health plans under similar circumstances did not require different result.