Garcia v. Centura Health Corp.
| Decision Date | 05 March 2020 |
| Docket Number | Court of Appeals No. 18CA1646 |
| Citation | 490 P.3d 629 |
| Court | Colorado Court of Appeals |
| Parties | Jina GARCIA, Plaintiff-Appellant, v. CENTURA HEALTH CORPORATION, Defendant-Appellee. |
Sawaya, Rose, McClure & Wilhite, P.C., Robert E. Caldwell, Denver, Colorado; The Hannon Law Firm, LLC, Kevin S. Hannon, Denver, Colorado, for Plaintiff-Appellant
Hall, Render, Heath & Lyman, P.C., Melvin B. Sabey, Denver, Colorado, for Defendant-Appellee
Burg Simpson Eldredge Hersh & Jardine, P.C., Nelson Boyle, Englewood, Colorado for Amicus Curiae Colorado Trial Lawyers Association
Opinion by JUDGE RICHMAN
¶ 1 Under Colorado's hospital lien statute, section 38-27-101, C.R.S. 2019, as amended in 2015, may a hospital place a lien on a person (1) who has been injured as a result of negligence or other wrongful acts and (2) whose primary health insurance is Medicare, without first billing Medicare? We answer "no" because in amending the statute, the General Assembly sought to protect insured patients from unnecessary liens — not to protect maximum payments to hospitals serving insureds.
¶ 2 Consequently, we reverse the district court order dismissing the claim of plaintiff, Jina Garcia, that defendant, Centura Health Corporation (Centura), violated the hospital lien statute when it filed a hospital lien against her before billing her primary health insurance. We also reverse the court's denial of Garcia's motion for summary judgment as to her individually.
¶ 3 Before 2015, the hospital lien statute provided, as relevant here, that "[e]very hospital ... which furnishes services to any person injured as the result of the negligence or other wrongful acts of another person ... shall ... have a lien for all reasonable and necessary charges for hospital care upon the net amount payable ... as damages on account of such injuries." § 38-27-101, C.R.S. 2014. Liens were limited in that they could not be filed to seek unreasonable or unnecessary charges, or any charges incurred after a judgment or settlement, or filed against persons covered by workers’ compensation; and the lien created under the statute was junior to an attorney's lien.
¶ 4 A division of this court interpreted the statute in the context of its purpose and its interaction with federal Medicare in Wainscott v. Centura Health Corp. , 2014 COA 105, 351 P.3d 513, an opinion on which the district court heavily relied. The division recognized that the intent of the statute was "to protect hospitals that provide medical services to an injured person who may not be able to pay but who may later receive compensation for such injuries which includes the cost of the medical services provided." Wainscott , ¶ 29 (emphasis added) (quoting Rose Med. Ctr. v. State Farm Mut. Auto. Ins. Co. , 903 P.2d 15, 16 (Colo. App. 1994) ).
¶ 5 The Wainscott division rejected the plaintiffs’ claim that the failure of the hospital to disclose to them that it would not bill Medicare constituted a violation of the Colorado Consumer Protection Act. Affirming the district court's ruling that the hospital did not have a duty to inform them that it was going to "bill in a certain way," the division observed that under federal law, Medicare serves as a secondary payer "when another insurer is responsible for providing primary coverage." Id. at ¶¶ 66-68 ; see 42 U.S.C. § 1395y(b)(2) (2018). Accordingly, Wainscott recognized that under federal law, hospitals must bill a tortfeasor's liability insurer before billing Medicare. Wainscott , ¶ 71 ; see 42 C.F.R. § 489.20(g) (2019). Additionally, Wainscott noted that Medicare will make conditional payments to the hospital if the liability insurer "has not made or cannot reasonably be expected to make payment ... promptly ...."1 Wainscott , ¶ 70 (quoting 42 U.S.C. § 1395y(b)(2)(B)(i) ); see 42 C.F.R. § 411.52(a)(1) (2019). But Wainscott was not interpreting the language now in the statute, which requires hospitals to bill the "primary medical payer of benefits" before filing a lien, § 38-27-101(1), C.R.S. 2019, nor was it juxtaposing that language against the federal description of Medicare as a "secondary payer." Thus, we do not find Wainscott informative on the statutory interpretation question now before us.
¶ 6 Seeking to curb the use of liens against accident victims who could pay their hospital bills through their own insurance, the Colorado legislature substantially amended the hospital lien statute in 2015. Ch. 260, sec. 1, § 38-27-101, 2015 Colo. Sess. Laws 981-82. As amended, and as relevant here, the statute provides:
§ 38-27-101 (emphases added).
¶ 7 There is no question that, under the current version of the statute, hospitals must bill a patient's primary private health insurance provider (such as BlueCross/BlueShield) before filing a lien. But in this case and in others currently working their way through Colorado courts, Centura seeks to dodge the pre-billing requirement as it would apply to Medicare. Arguing that Medicare is not a "primary" medical payer of benefits because Medicare defines itself as a secondary payer in cases of wrongful injury, Centura seeks to recover the full amount of its hospital bills from accident victims through filing a lien, rather than the discounted amount that Medicare would pay if it were billed. We reject the notion that the General Assembly intended the 2015 amendments to create such a loophole.
¶ 8 The following facts are undisputed. Garcia was treated at Centura-St. Anthony North (the hospital) for injuries sustained in an automobile accident on April 10, 2017. She told the hospital at the time of her treatment that Medicare, Medicaid, and Progressive (her property and casualty insurance carrier) were her insurers. Centura's agent billed Progressive four days later and was informed that Garcia's policy did not cover medical care.3 Less than a month after Garcia's hospital visit, Centura filed a lien against her for $2170.35, without first billing Medicare. On May 24, Centura notified Garcia that the charges would not be billed to Medicare or Medicaid at that time.
¶ 9 In July, exercising the right of action granted by section 38-27-101(7), Garcia filed a complaint against Centura, individually and on behalf of a class of others similarly situated, seeking, as relevant here, an award of twice the amount of the hospital lien(s) asserted.
¶ 10 In September, Centura released the lien and moved to dismiss Garcia's claims.4 Garcia cross-moved for summary judgment. The district court ruled in favor of Centura on both motions, finding a potential conflict between section 38-27-101 and federal law and thus narrowly interpreting the term "primary medical payer of benefits" to exclude Medicare and Medicaid.
¶ 11 We review de novo the district court's grant of Centura's motion to dismiss and its denial of Garcia's motion for summary judgment. BRW, Inc. v. Dufficy & Sons, Inc. , 99 P.3d 66, 71 (Colo. 2004). We begin by interpreting the hospital lien statute, as amended in 2015, de novo. See Colo. Med. Bd. v. McLaughlin , 2019 CO 93, ¶ 22, 451 P.3d 841. In doing so, we first consider whether the General Assembly intended Medicare to be a "primary medical payer of benefits" as applied to Garcia under the statute, and we conclude that it did. We then consider the consequences of that interpretation, including whether requiring Centura to bill Medicare is "permitted by state and federal law." § 38-27-101(1).
¶ 12 "Our fundamental responsibility in interpreting a statute is to give effect to the General Assembly's purpose or intent in enacting the statute." Martin v. People , 27 P.3d 846, 851 (Colo. 2001). To effect that intent, we look first to the statute's plain language, construing words and phrases "according to grammar and common usage" and considering the statute as a whole. Jefferson Cty. Bd. of Equalization v. Gerganoff , 241 P.3d 932, 935 (Colo. 2010).
¶ 13 If the statute lends itself to reasonable alternative constructions, "a court may apply other rules of statutory construction and look to pertinent legislative history to determine which alternative construction is in accordance with the objective sought to be achieved by the legislation." People v. Terry , 791 P.2d 374, 376 (Colo. 1990).
¶ 14 We presume that the General Assembly intended a just and reasonable result and that "[p]ublic interest is favored over any private interest." § 2-4-201(1)(c), (e), C.R.S. 2019.
¶ 15 Here, based on the plain language in subsections (1) and (9) of section 38-27-101, and because the General Assembly used the conjunctive "and" in subsection (1), we conclude that the General Assembly intended to require hospitals to bill...
To continue reading
Request your trial
-
Owens v. Williams
...summary judgment"); Churchey v. Adolph Coors Co. , 759 P.2d 1336, 1339 (Colo. 1988) ; Garcia v. Centura Health Corp. , 2020 COA 38, ¶ 50, 490 P.3d 629. We review a district court's summary judgment de novo. Burton v. Colo. Access , 2018 CO 11, ¶ 19, 428 P.3d 208. Summary judgment is proper ......
-
Harvey v. Catholic Health Initiatives
...property and casualty insurer and the primary medical payer of benefits. Id.; accord Garcia v. Centura Health Corp., 2020 COA 38, ¶ 15, 490 P.3d 629, 633; Harvey, ¶ 15, 490 P.3d at 567. In addition, statute requires hospitals to submit the above-described charges only "to the extent permitt......