Larisa's Home Care, LLC v. Nichols-Shields

To determine if an injustice exists for purposes of an unjust enrichment claim, one of the following factors must be present: (1) the plaintiff had a reasonable expectation of payment; (2) the defendant should reasonably have expected to pay; or (3) society’s reasonable expectations of security of person and property would be defeated by non-payment.

Nichols-Shields appealed the trial court’s denial of a motion to dismiss that Nichols-Shields made during closing argument. Nichols-Shields claimed that Larisa’s Home Care’s claim must fail as a matter of law because Larisa’s Home Care did not offer evidence sufficient to establish a prima facie claim for unjust enrichment. This Court reviews three factors to determine if an injustice exists for purposes of an unjust enrichment claim: (1) the plaintiff had a reasonable expectation of payment; (2) the defendant should reasonably have expected to pay; or (3) society’s reasonable expectations of security of person and property would be defeated by non-payment. This Court holds that it is not unjust for Nichols-Shields not to pay Larisa’s Home Care the difference between the Medicaid rate and the private-pay rate because Nichols-Shields is not retaining the benefit obtained as a result of improper Medicaid qualification. In addition, Larisa’s Home Care had no expectation of being paid the private-pay rate because it accepted Prichard as a Medicaid client and was under contract with the state to be paid the contracted rate. This Court does not find evidence that Nichols-Shields reasonably expected to pay. Finally, this Court does not find evidence that society’s reasonable expectations of security of person and property would be defeated by non-payment. Awarding Larisa’s Home Care the difference between the Medicaid rate and the private-pay rate would defeat societal expectations, not further them, because Nichols-Shields is already Medicaid eligible. Reversed.