Mcg Health Inc. v. Owners Ins. Co..

• Decision Date: 18 March 2011
• Docket Number: No. S10G1142.,S10G1142.
• Citation: 288 Ga. 782,707 S.E.2d 349
• Parties: MCG HEALTH, INC.v.OWNERS INSURANCE COMPANY.
• Court: Georgia Supreme Court

288 Ga. 782

707 S.E.2d 349

11 FCDR 102

11 FCDR 1328

MCG HEALTH, INC.

v.OWNERS INSURANCE COMPANY.

No. S10G1142.

Supreme Court of Georgia.

Jan. 24, 2011.Reconsideration Denied March 18, 2011.

Hull, Towill, Norman, Barrett & Salley, David E. Hudson, Christopher A. Cosper, Augusta, Robert L. Allgood, for appellant.Talley French & Kendall, Michael C. Kendall, Conyers, Nicholson Revell, Sam G. Nicholson, Augusta, Harry D. Revell, Bell & Bell, David B. Bell, Augusta, Bell & Brigham, John C. Bell, Jr., Pamela S. James, for appellee.Alston & Bird, Donna P. Bergeson, Atlanta, Turkheimer & Hadden, John D. Hadden, Daughtery, Crawford, Fuller & Brown, Jason L. Crawford, Columbus, for amicus curiae.BENHAM, Justice.

This case arises from the dismissal of a complaint filed by MCG Health, Inc. (“MCG”), against Owners Insurance Company (“Owners”). In sum, MCG filed a hospital lien for services provided to Braxton Morgan at the Medical College of Georgia after he was injured in an automobile accident caused by an individual insured by Owners. MCG then brought an action against Owners to collect on the lien. The trial court treated third-party defendants Braxton and Kylie Morgan's cross-motion to dismiss the complaint as a motion for summary judgment and granted it, effectively dismissing MCG's complaint for failing to state a claim for which relief could be granted. The Court of Appeals affirmed the decision in MCG Health, Inc. v. Owners Ins. Co., 302 Ga.App. 812, 692 S.E.2d 72 (2010). We granted certiorari to consider whether the Court of Appeals erred in its construction of OCGA § 44–14–470. We now affirm the judgment.

The underlying facts show that at the time Morgan received treatment at MCG, he was an active duty member of the United States Army covered by the United States Department of Defense TRICARE health insurance program (“TRICARE”). ¹ MCG had a contract with Humana Military Healthcare Services, Inc. (“HMHS”) to provide certain healthcare services to beneficiaries of the TRICARE program. The contract set forth the terms by which MCG could recover for services provided to TRICARE beneficiaries. Paragraphs 2 and 4 required MCG to comply with TRICARE regulations. In addition, section 17 of the contract provided in pertinent part:

No Liability to Beneficiaries for Charges. Hospital hereby agrees that in no event, including, but not limited to nonpayment by HMHS or the Government, HMHS insolvency or breach of this Agreement, shall Hospital bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement or have any recourse against Beneficiaries, or persons other than HMHS acting on their behalf, for Covered Services provided pursuant to this Agreement. This Hospital Agreement provision shall not prohibit collection of fees for any non-covered service and/or Copayments in accordance with the terms of the Beneficiary's coverage and this Agreement.

Nothing in this Agreement shall be construed to limit the Hospital's rights under OCGA § 44–14–470 et seq. Hospital shall have the right to seek to recover its charges, to the extent that said charges exceed what Health Plan or Payor pays Hospital pursuant to this Agreement, incurred as a result of Hospital's providing Hospital Services to Members and which charges are the liability of a third party. The parties further agree that payment by Health Plan or Payor to Hospital does not extinguish Hospital's lien or in any way limit Hospital's rights under OCGA § 44–14–470 et seq., except that the amount of the Hospital's lien shall not include the amount of any payment(s) by Health Plan or Payor to Hospital on behalf of a Member.

In addition, Chapter 11, Section 5 of the TRICARE handbook, which was attached and incorporated into the contract, stated in pertinent part as follows: 5.5.2. It is important to note that prior to submission of a TRICARE claim, the hospital is not precluded from seeking recovery of its billed charge directly from the liable third party or insurer.... However, the hospital may not bill the beneficiary without filing a TRICARE claim.

The total cost of the services MCG provided to Morgan was $18,259.61. Relying on the above-referenced language in section 17 of the contract referring to Georgia's hospital lien statute and section 5.5.2 of the TRICARE manual, MCG filed a hospital lien for the full cost of services provided to Morgan pursuant to OCGA § 44–14–470 et seq. MCG did not file a claim with TRICARE for Morgan's treatment at any time before or after filing the hospital lien. After MCG filed the hospital lien, Morgan entered into a release and settlement agreement with Owners for $50,000. MCG then filed a claim against Owners to collect on its lien.

In dismissing MCG's claim on partial summary judgment, the trial court determined the TRICARE contract, as well as federal statutes and regulations governing the TRICARE program, effectively precluded MCG from recovering its fees from Owners.² The Court of Appeals affirmed on different grounds, concluding overall that MCG had a right under the contract to pursue a lien, but that the basis of the hospital's right to a lien was a patient debt and that, in this case, the lien was invalid because there was no patient debt for the lien to attach. More specifically, due to the fact that the patient was immune from debt based on the contract, there was no debt owing for the hospital to collect. MCG Health, Inc. v. Owners Ins. Co., 302 Ga.App. at 818–819, 692 S.E.2d 72.

1. MCG contends that the Court of Appeals erred when it held that the debt

must be owed by the patient in order for a hospital to foreclose on a lien. We agree. The Court of Appeals came to its decision by interpreting OCGA § 44–14–470(b) ³ of the hospital lien statute to require that the debt belong to the patient/beneficiary in order for the lien to be valid and collectable. As the Court of Appeals acknowledged, the hospital lien statute is silent as to whether the debt must be the obligation of the patient or the obligation of some other person or entity. See MCG Health Inc. v. Owner's Ins. Co., 302 Ga.App. at 817, 692 S.E.2d 72 (“The statute does not state whether or not it requires the existence of a debt to support enforcement.”) “In this situation, we must apply the concepts of expressio unius est exclusio alterius (the expression of one thing implies the exclusion of another) and expressum facit cessare tacitum (if some things are expressly mentioned, the inference is stronger that those not mentioned were intended to be excluded).” Goddard v. City of Albany, 285 Ga. 882, 884, 684 S.E.2d 635 (2009). Under this basic tenet of statutory construction, the Court of Appeals was not authorized to impose a requirement to the statute that was not expressly stated therein.⁴ The error is inapposite, however, because the resolution of this case does not turn on the construction or interpretation of Georgia's hospital lien statute, but is resolved by adhering to the federal statutory and regulatory scheme governing the administration of the TRICARE program.

2. MCG contends it has a right to pursue a lien under Georgia's hospital lien statute. For the reasons set forth below, we disagree.

(a) The statutory and regulatory scheme which governs TRICARE does not provide any basis for allowing a contracting civilian healthcare provider such as MCG to collect its treatment costs from a third-party tortfeasor/payer. Specifically, in this context, it is the federal government that has the right of collection against such third-party tortfeasor or its insurer pursuant to the Federal Medical Care Recovery Act (FMCRA), 42 U.S.C. §§...