YUKON-KUSKOKWIM v. TRUST INS. PLAN FOR SW ALASKA
| Decision Date | 14 February 1994 |
| Docket Number | No. A92-747 CIV (JWS).,A92-747 CIV (JWS). |
| Citation | 884 F. Supp. 1360 |
| Parties | YUKON-KUSKOKWIM HEALTH CORPORATION, INC., Plaintiff, v. TRUST INSURANCE PLAN FOR SOUTHWEST ALASKA, Defendant. TRUST INSURANCE PLAN FOR SOUTHWEST ALASKA, Third-Party Plaintiff, v. PROVIDENT LIFE & ACCIDENT INSURANCE COMPANY, Third-Party Defendant. |
| Court | U.S. District Court — District of Alaska |
Lloyd Benton Miller of Sonosky, Chambers, Sachse, Miller, Munson & Clocksin, for plaintiff Yukon-Kuskokwim Health Corp., Inc.
William K. Jermain of Jermain, Dunnagan & Owens, P.C., for defendant and third-party plaintiff Trust Ins. Plan for Southwestern Alaska.
John Wendlandt of Hughes, Thorsness, Gantz, Powell & Brundin, for third-party defendant Provident Life & Acc. Ins. Co.
Susan Lindquist of the U.S. Atty. Office, for U.S.
ORDER FROM CHAMBERS
Plaintiff Yukon Kuskokwim Health Corporation (YKHC) sues defendant Trust Insurance Plan of Southwest Alaska (TIPSA) to recover payments for health services it provided Native Alaskans after November 23, 1988. TIPSA is a trust created under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (ERISA) and comprised of multiple private and public employers located in southwest Alaska. Pursuant to this court's Order dated May 27, 1993, the parties have filed several motions for summary judgment attempting to narrow and define the scope of the issues presented by YKHC's complaint. Oral argument was heard on January 11, 1994, on YKHC's Motion for Partial Summary Judgment Regarding the "Statutory Exceptions" to the Right of Recovery Under Section 206 of the Indian Health Care Improvement Act, and its Motion for Partial Summary Judgment Regarding TIPSA's Defense of Claim Procedures.
Defendants have also filed motions for partial summary judgment concerning YKHC's standing to assert claims prior to 1992, and challenging the United States' ability to differentiate between private insurers and the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). YKHC has cross-moved for partial summary judgment dismissing TIPSA's equal protection affirmative defense. The parties did not request oral argument on the issues of standing or equal protection.
YKHC is a consortium of 50 Alaska Native Village tribes located near the Yukon and Kuskokwim Rivers. YKHC administers health care services to Alaska Natives through operation of the Yukon-Kuskokwim Delta Regional Hospital (Hospital) and the Yukon-Kuskokwim Dental Clinic (Dental Clinic). YKHC has operated the Dental Clinic since prior to November 23, 1988, but assumed operation of the Hospital on October 1, 1991. Prior to that date the Indian Health Service (IHS) operated the Hospital.
YKHC operates under an Indian Self-Determination Act contract with the Indian Health Service and Public Health Service of the United States Department of Health and Human Services (Contract No. XXX-XX-XXXX). Since November 23, 1988, YKHC and/or IHS have provided health care services to Alaska Natives insured by TIPSA, a trust comprised of several southwestern Alaska employers with high numbers of Native employees.1 TIPSA provides group insurance to its sponsors' employees.2
YKHC required all Alaska Natives to sign a document entitled "Authorization to Furnish Information and Assignment of Benefits for Private Insurance" prior to receiving health care. The document assigned the individual's insurance claims to YKHC. YKHC has submitted claims for payment to TIPSA for health care services provided to Alaska Natives. TIPSA routinely denied those claims, based upon its conclusion that its Alaska Native beneficiaries are not legally obligated to pay for health services received from government contractors such as YKHC. TIPSA excludes coverage of:
TIPSA Group No. 1100 Employee Benefits Plan, October 1, 1990 (emphasis in original).3
TIPSA also denied YKHC's claims as having been improperly submitted. TIPSA requires that the individual beneficiary, rather than the health care provider, submit the claim and that the employer verify the employee's coverage. TIPSA sends any claim received from a health care provider to the individual, along with a "revocation kit," which includes a notice informing the individual that if he or she files a claim and it is required to pay, premium costs will be raised and the individual will suffer reduced medical options. The notice concludes:
This means that if you don't file a claim with the insurance company for services provided to you by the Indian Health Service, neither you nor your insurance company TIPSA can be forced to pay for such services.
On October 29, 1992, Congress passed the Indian Health Amendments of 1992, Pub.L. No. 102-508, § 209, 106 Stat. 4526, 4551 (1992), which amended the Indian Health Care Improvement Act, 25 U.S.C. § 1621e(a), to expressly provide tribal organizations with a right of recovery to collect the reasonable costs of health care provided to Native Americans and Alaska Natives from third party insurers. On December 9, 1992, YKHC initiated this suit to recover over $700,000 in unpaid medical claims for services allegedly provided to Alaska Natives insured by TIPSA arising after November 23, 1988. The United States has intervened in the action, and also asserts claims against TIPSA for services allegedly provided to Alaska Natives insured by TIPSA.
YKHC sues TIPSA, pursuant to 25 U.S.C. § 1621e, to recover the reasonable cost of health care provided to Alaska Native TIPSA beneficiaries from November 23, 1988, to the present.4 The Indian Health Amendments of 1992 amended § 1621e to expressly permit Indian tribes and tribal organizations to recover health care expenses to the same extent that the individual recipient, or nongovernmental provider of such services, could receive reimbursement, assuming that the services had been provided by a nongovernmental provider, that the individual was required to pay for the services, and did pay for the services. Additionally, the Indian Health Amendments of 1992 omitted the term "political subdivision" from 25 U.S.C. § 1621e(b) and added § 1621e(f).5
TIPSA's answer asserts several affirmative defenses to challenge YKHC's claims on statutory grounds. First, TIPSA claims that § 1621e, as originally enacted, did not grant YKHC the right to assert claims for medical services provided to its Alaska Native beneficiaries. Second, TIPSA believes YKHC's claims must be denied because the political subdivision and self-insured exceptions contained in 25 U.S.C. §§ 1621e(b) and (f), respectively, apply, although it has conceded that the political subdivision exception does not bar all of YKHC's claims. Third, TIPSA contests liability because YKHC allegedly failed to follow valid claim procedures. Fourth, TIPSA alleges that § 1621e violates its right to equal protection under the Fifth Amendment of the United States Constitution.
TIPSA argues that from November 23, 1988, the date 25 U.S.C. § 1621e(a) became effective, until Congress enacted the Indian Health Amendments of 1992, tribal organizations such as YKHC did not have a statutory right to recover health care costs provided to Alaska Natives. Though TIPSA refers to YKHC's lack of "standing," its argument is better characterized as asserting that YKHC has failed to state a claim for relief under § 1621e(a) prior to October 29, 1992. TIPSA does not deny YKHC provided services to its Alaska Native beneficiaries or that TIPSA denies coverage for those claims. YKHC clearly has standing to assert its claims to recover the reasonable costs of those health services. The issue is whether YKHC may take advantage of § 1621e to avoid TIPSA's policy exclusions. This depends upon whether the 1992 amendments apply retroactively.6
The unsettled nature of retroactive application of federal laws is well documented. See Kaiser Aluminum and Chem. Corp. v. Bonjorno, 494 U.S. 827, 841, 110 S.Ct. 1570, 1579, 108 L.Ed.2d 842 (1990) (Scalia, J., concurring); Kent v. Howard, 801 F.Supp. 329, 335 (S.D.Cal.1992). The genesis of the dispute is found in the Supreme Court's opinions in Bradley v. Richmond Sch. Bd., 416 U.S. 696, 94 S.Ct. 2006, 40 L.Ed.2d 476 (1974), and Bowen v. Georgetown Univ. Hosp., 488 U.S. 204, 109 S.Ct. 468, 102 L.Ed.2d 493 (1988). In Bradley, the Supreme Court adopted a presumption in favor of retroactive application of new laws "unless doing so would result in manifest injustice or there is statutory direction or legislative history to the contrary." 416 U.S. at 711, 94 S.Ct. at 2015. In Bowen, the Court stated: 488 U.S. at 208, 109 S.Ct. at 471. The tension between Bradley and Bowen was recognized in Kaiser Aluminum and Chem. Corp. v. Bonjorno, 494 U.S. 827, 841, 110 S.Ct. 1570, 1579, 108 L.Ed.2d 842 (1990), but not resolved because in that instance clear congressional intent, gleaned from the plain language of the statute, made manifest that the law did not apply prior to its effective date.7
The Ninth Circuit also has published contradictory decisions regarding retroactivity. Compare ...
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