While Matthiesen, Wickert & Lehrer, S.C. (MWL) attorneys are actively pursuing subrogation and reimbursement claims around the country for health insurers and plans alike, we are increasingly being asked to defend clients from out-of-network lawsuits by providers. These out-of-network or “usual, customary and reasonable charges” cases are not novel. In recent memory, these claims have…
In Humana v. Farmers Texas County Mutual, et al., 13-cv-006111 (W.D. Tex. Sept. 24, 2014), the plaintiff, a Medicare Advantage Organization (MAO), sought reimbursement from a no-fault automobile insurer. The magistrate judge previously granted the defendant’s motion to dismiss holding that MAOs did not possess a private right of action under the Medicare Secondary Payer…
For the time being, trial lawyers are celebrating the recent 2nd Circuit decision in Wurtz v. Rawlings Co., LLC, 2014 WL 3746801 (2nd Cir. 2014), which on July 31st, held that a class action suit seeking to enjoin three defendants from seeking reimbursement of benefits paid under fully-insured health plans based on New York’s anti-subrogation…
Health insurers and health insurance professionals can close their eyes and hope that the so-called Patient Protection and Affordable Care Act (ACA) becomes a distant memory in their rear-view mirror, but the truth is that for now, it is the law, and it may be here to stay. While we are told that the number…
The U.S. government sponsors more than 350 different health Plans covering more than nine million federal employees, retirees, and beneficiaries through the Federal Employees Health Benefit Act of 1959 (FEHBA). 5 U.S.C. §§ 8901-8914. Like it’s counterpart in the private market, ERISA, the FEHBA does not mention or provide for rights of reimbursement or subrogation.…
On August 26, 2010, DePuy Orthopaedics, Inc. (DePuy), a division of Johnson & Johnson, issued a voluntary recall of the DePuy ASR™ XL Acetabular System and ASR Hip Resurfacing Device – a total hip replacement system. It involves not only the replacement of the joint (ball and socket), but also the “neck” of the femur.…
Following closely on the heels of an unfavorable decision, state legislators in Albany wasted no time embarking on a rescue mission to save New York’s anti-subrogation statute from ERISA preemption. McKinney’s G.O.L. §§ 5-101 and 5-335. The statute, originally enacted in 2009, was purportedly an attempt to protect parties to settlements of tort claims from…
One of the more common misconceptions one hears in the realm of health and accident subrogation is that, when it comes to motor vehicle accidents, “there is no subrogation in Michigan.” No one can deny that the Michigan No-Fault Act presents an abundance of obstacles for a carrier looking to recover medical and wage loss…
Drastic Re-Write of Comp Law Provides New Subrogation Options In the 1970s, the Oklahoma Sooners’ football team successfully began implementing a new offensive system known as the “option offense.” Sooner Coach Barry Switzer has been credited by many for having perfected the use of the wishbone offense, a staple of option offenses. Forty years later,…
It is said that releases and settlement agreements “use a hundred words when ten would do” and there is a good reason for that. Those drafting the release want to include as much as possible within the future protections, claims released, and indemnity provided by the document. Conversely, those signing the release want to limit…