25 April 2018

Successful Outcome for Metron of Big Rapids on Medicare Secondary Payer Claim

The Case

Miller Johnson secured favorable results in Greenridge Nursing Center, Inc., d/b/a Metron of Big Rapids v Home-Owners Insurance Company in a jury trial in Mecosta County, Michigan.  The March 2018 final award was for nearly $900,000 for Metron of Big Rapids.

The case involved a dispute over nursing care provided by Metron of Big Rapids, and whether that care was for injuries Metron of Big Rapids’ patient suffered in a motor vehicle accident.  Home-Owners refused to provide coverage based upon its claim that the care was not for accident-related injuries.  This required Medicare to step in and pay for some of that care.

Metron of Big Rapids sued Home-Owners as both an assignee under Michigan’s No-Fault Act and under the Medicare Secondary Payer Act, a federal law providing for double damages where a primary insurer refuses payment and Medicare later pays.  Following a three- day trial in February, the jury returned a verdict for Metron, entitling it to double damages on the award.

The case was led by Miller Johnson attorney Joe Gavin with team of Ryan Duffy (attorney) and Julie Cosgrove (paralegal).

The Client

Metron of Big Rapids is a 100 bed facility with 32 private rooms offering sub-acute rehabilitation services, skilled nursing care, and clinically complex care to patients.  Metron of Big Rapids’ parent company, Metron Integrated Health Systems (MIHS), provides services throughout Michigan as a leader in health care.  MIHS combines medical excellence and expertise with a caring customized patient focus, resulting in high quality care with improvement in functional independence.

Miller Johnson’s Healthcare Reimbursement Group

Miller Johnson’s Healthcare Reimbursement Group provides litigation and counseling to medical providers seeking insurance reimbursement on patient accounts. Our attorneys pursue wrongful denials of hospital claims by third-party payers, including no-fault carriers, health insurance plans and government plans.

In addition to appealing and litigating denied claims, attorneys provide training to patient financial services representatives on billing and coding issues, no-fault eligibility and coverage issues, appeals to government payers, HMOs and ERISA plans on denied claims and compliance under the Fair Debt Collection Practices Act.