MCG Health, Inc. v. Owners Insurance
288 Ga. 782
| Ga. | 2011Background
- MCG Health, Inc. provided hospital services to TRICARE beneficiary Braxton Morgan after an automobile accident caused by an insured by Owners Insurance Company.
- MCG had a contract with Humana Military Healthcare Services to recover charges from TRICARE beneficiaries, including section 17 limiting collection from beneficiaries and allowing liens for third-party liability to the extent charges exceed what Health Plan pays.
- Paragraph 17 prohibited charging or recourse against TRICARE beneficiaries, but stated that it does not limit rights under OCGA § 44-14-470 et seq. and that payment by Health Plan or Payor does not extinguish a hospital lien, except that lien amounts cannot include payments by Health Plan or Payor on the Member's behalf.
- TRICARE Handbook Chapter 11, § 5.5.2 indicated pre-submission of a TRICARE claim allows hospitals to seek recovery from liable third parties but prohibits billing the beneficiary without filing a TRICARE claim.
- MCG filed a hospital lien for $18,259.61 under OCGA § 44-14-470 et seq.; no TRICARE claim had ever been filed by MCG.
- Morgan settled with Owners for $50,000; MCG then sought to collect on its lien from Owners, which the trial court dismissed as failing to state a claim; Court of Appeals affirmed on alternative grounds; Georgia Supreme Court granted certiorari.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does federal TRICARE law preempt Georgia hospital lien recovery from a third party? | MCG contends state lien rights may exist notwithstanding TRICARE/Federal law. | Owners argues TRICARE/ FMCRA preempts any state-law lien against third parties. | Yes; preemption forecloses recovery from the third party under state lien statutes. |
| Can MCG pursue a hospital lien against a TRICARE beneficiary's tortfeasor under OCGA § 44-14-470 when TRICARE regulations govern recovery? | MCG argues the statute permits a lien irrespective of TRICARE regime. | TRICARE regime and FMCRA prohibit such collection by a private provider. | Preempted; TRICARE/Federal law bars collection from the tortfeasor via state lien. |
| Does the contract provision prohibiting recourse against beneficiaries bar lien collection from the tortfeasor? | MCG relies on contract language to support a lien against third parties. | Federal law governs TRICARE and overrides the contract to prevent such recourse. | Contract cannot override federal TRICARE restrictions; lien collection is barred. |
Key Cases Cited
- Thurman v. State Farm Mut. Auto. Ins. Co., 278 Ga. 162 (2004) (TRICARE-related issues and preemption principles applicable to private liens)
- Bradley v. Sebelius, 621 F.3d 1330 (11th Cir. 2010) (agency manuals do not have force of law; TRICARE context)
- Goddard v. City of Albany, 285 Ga. 882 (2009) (statutory interpretation principles; expressio unius est exclusio alterius)
- Davis v. State, 287 Ga. 414 (2010) (right-for-any-reason rule in affirming lower courts)