Harvey v. Centura Health Corp.
| Decision Date | 30 January 2020 |
| Docket Number | Court of Appeals No. 19CA0091 |
| Court | Colorado Court of Appeals |
| Parties | Peggy HARVEY, Plaintiff-Appellant, v. CENTURA HEALTH CORPORATION and Catholic Health Initiatives, d/b/a Centura Health Saint Anthony Hospital, Defendants-Appellees. |
Franklin D. Azar & Associates, P.C., Robert E. Markel, Aurora, Colorado, for Plaintiff-Appellant
McConnell Van Pelt, LLC, Traci L. Van Pelt, David A. Belsheim, Denver, Colorado, for Defendants-Appellees
Opinion by JUDGE WEBB
¶ 1 Does section 38-27-101(1), C.R.S. 2019, of the hospital lien statute require a hospital to bill Medicare and Medicaid for medical services before creating a lien against the person who received the services, when that person is covered by other insurance? We answer this novel question "no." For that reason, we do not reach the question whether federal law preempts the statute. Therefore, we affirm the summary judgment entered in favor of defendants, Centura Health Corporation and Catholic Health Initiatives (collectively, Centura), and against plaintiff, Peggy Harvey.
¶ 2 In the trial court, the following facts were undisputed.
¶ 3 Ms. Harvey suffered injuries when a truck driven by an employee of Gibbons Erectors, Inc., rear-ended her vehicle. On April 2, 2018, a few days after the accident, Centura provided medical services to her. At the time of the accident and when she received treatment, Ms. Harvey was a Medicare beneficiary and a Medicaid recipient. She presented Centura with proof of her eligibility for these benefits.
¶ 4 Centura billed her $15,611.39 for its services. Centura also sent the bill to Gibbons. After not receiving payment, Centura assigned the bill to Avectus Health Care Solutions for collection.
¶ 5 Geico Insurance Company insured Ms. Harvey. The coverage included medical expenses. Travelers Insurance Company insured Gibbons. When contacted by Avectus on May 9, Ms. Harvey provided her Geico policy number and her claim number with Travelers.
¶ 6 Avectus contacted both Geico and Travelers. On May 15, Avectus resubmitted the bill to Gibbons. Two days later, Avectus submitted the bill to Geico. Then on May 25, Avectus filed a hospital lien on Centura's behalf and against Ms. Harvey in the billed amount.
¶ 7 The record does not show that either Centura or Avectus ever billed Medicare or Medicaid. On June 12, Geico told Avectus that it was withholding payment of the Centura bill pending an agreement with Ms. Harvey's attorney concerning allocation of settlement proceeds. The bill remained unpaid.
¶ 8 Ms. Harvey brought this action alleging that by filing the lien before billing Medicare and Medicaid, Centura violated section 38-27-101(1). Under section 38-27-101(7), she sought damages of twice the amount of the lien. Centura moved to dismiss. The trial court treated the motion as one for summary judgment and granted it. Ms. Harvey does not challenge the ruling based on any disputed issue of material fact.1
¶ 9 Summary judgment is reviewed de novo, applying the same standard as the trial court. Blakesley v. BNSF Ry. Co. , 2019 COA 119, ¶ 11, 459 P.3d 715. It is appropriate only when no genuine issue of material fact exists and the moving party is entitled to judgment as a matter of law. C.R.C.P. 56(c).
¶ 10 Statutory interpretation is a question of law that is also reviewed de novo. Ryser v. Shelter Mut. Ins. Co. , 2019 COA 88, ¶ 11, 486 P.3d 344. That review is guided by several familiar principles, including the following.
¶ 11 Section 38-27-101(1) authorizes a hospital to create a lien for services and care provided to persons "injured as the result of the negligence or other wrongful acts of another person." Such a lien — which is second in priority only to an attorney's lien — is intended "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." Rose Med. Ctr. v. State Farm Mut. Auto. Ins. Co. , 903 P.2d 15, 16 (Colo. App. 1994) (); see also Trevino v. HHL Fin. Servs., Inc. , 945 P.2d 1345, 1350 (Colo. 1997) ().
¶ 12 Allowing hospitals to create liens for services and care "furthers the important policy of reducing the amount of litigation that would otherwise be necessary to secure repayment of the health care debts." Wainscott v. Centura Health Corp. , 2014 COA 105, ¶ 30, 351 P.3d 513 (quoting Cmty. Hosp. v. Carlisle , 648 N.E.2d 363, 365 (Ind. Ct. App. 1995) ). As well, such liens "benefit the public by encouraging hospitals to treat patients without first determining their ability to pay." Id. at ¶ 31.
¶ 13 In 2015, the General Assembly "significantly amended" section 38-27-101 to impose, for the first time, requirements that must be satisfied before a lien can be created. Marchant v. Boulder Cmty. Health, Inc. , 2018 COA 126M, ¶ 7, 436 P.3d 590 ; see Ch. 260, sec. 1, § 38-27-101, 2015 Colo. Sess. Laws 981-83. Section 38-27-101(1) now provides:
Before a lien is created, every hospital ... which furnishes services to any person injured as the result of the negligence or other wrongful acts of another person ... shall submit all reasonable and necessary charges for hospital care or other services for payment to the property and casualty insurer and the primary medical payer of benefits available to and identified by or on behalf of the injured person, in the same manner as used by the hospital for patients who are not injured as the result of the negligence or wrongful acts of another person, to the extent permitted by state and federal law .
(Emphasis added.)
¶ 14 Ms. Harvey contends Centura violated section 38-27-101(1) by creating a lien for the cost of her medical care without first billing Medicare and Medicaid. Centura concedes preservation. We discern no violation.
¶ 15 Section 38-27-101(1) requires a hospital — before creating a lien — to submit reasonable and necessary charges for hospital care to the property and casualty insurer and the primary medical payer of benefits available to and identified by the injured person. Although the parties disagree as to when (if ever) Medicare and Medicaid become a "primary medical payer of benefits," mere disagreement about the application of statutory language does not create an ambiguity. Morley v. United Servs. Auto. Ass'n , 2019 COA 169, ¶ 16, 465 P.3d 71. Indeed, at oral argument, both Centura and Ms. Harvey agreed that the statute is unambiguous.
¶ 16 While section 38-27-101 leaves "primary" payer of benefits undefined, it does define "payer of benefits" generally. See § 38-27-101(9). This definition includes an insurer, a health maintenance organization, a health benefit plan, a preferred provider organization, an employee benefit plan, a program of medical assistance under the "Colorado Medical Assistance Act," "[a]ny other insurance policy or plan," or "[a]ny other benefit available as a result of a contract entered into and paid for by or on behalf of an injured person." Id. Everyone before us agrees that this definition includes Medicare and Medicaid.
¶ 17 Still, had the General Assembly intended for section 38-27-101(1) to include all payers of benefits, it would not have used the limiting word "primary." See Sooper Credit Union v. Sholar Grp. Architects, P.C. , 113 P.3d 768, 772 (Colo. 2005) ( ). Because the General Assembly included this word, we must assume that it did so intentionally. Lombard , 187 P.3d at 571 .
¶ 18 Under section 38-27-101(1), a hospital must submit charges to the primary payer of medical benefits "to the extent permitted by state and federal law." So, to give effect to the word "primary" in section 38-27-101(1), we examine its use under state and federal law. As discussed below, doing so gives the phrase "primary payer" a particular meaning in the context of Medicare and Medicaid benefits that defeats Ms. Harvey's claim.
¶ 19 When the Medicare Program was enacted, it "served as the primary payer for all services to Medicare beneficiaries." Smith v. Farmers Ins. Exch. , 9 P.3d 335, 338 (Colo. 2000). But this changed in 1980, when Congress enacted the Medicare Secondary Payer (MSP) provisions, see 42 U.S.C. §...
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