A District Court judge in Florida has ruled that a defendant — a health insurance company — must face claims it failed to make appropriate payments to healthcare providers who subsequently assigned their claims to the plaintiff, Healthcare Ally Management of California, LLC, denying the defendant’s argument that the plaintiff needed to be licensed as a debt collector in the state in order to pursue its claim.
According to the complaint, prior to providing these services, the healthcare providers contacted the insurer to verify the reimbursement rate, which was allegedly confirmed as the “usual, customary, reasonable” (UCR) rate for the procedures. But the defendant paid the providers at the Medicare rate instead, which was significantly lower than the UCR rate. For example, one of the bills, initially totaling over $104,000, was allegedly reimbursed with a payment of just over $3,000.
After attempts to appeal the underpayments failed, the providers assigned the rights to these unpaid claims to HAMOC, which then filed the lawsuit.
One of the arguments made by the defendant in the motion to dismiss was that the plaintiff was not licensed as a debt collector in Florida and thus unable to pursue claims of repayment. The defendant also attempted to argue that the healthcare providers could not assign these claims to the plaintiff.
Judge Roy K. Altman agreed with the plaintiffs that a debt collector’s license is only required when collecting “run-of-the-mill debts” and not debts that are owed between a medical provider and an insurance company. The judge disagreed with the plaintiff that the underlying debts were owed by a consumer, which would then require the defendant to obtain a license.
“… any debt the patients might owe is utterly irrelevant to this action because [the plaintiff] is trying to collect a specific debt [the defendant] allegedly owes the Providers for the services the medical
professionals provided to their insureds — nothing more, nothing less,” Judge Altman wrote.
