When is a payment made in full, when it has not been paid in full? Medical bills every day are reduced, repriced or adjusted from original charges. An employer must introduce evidence to show the claimant’s liability is limited to the repriced or adjusted medicaid fees.
The employer has the burden to show a claimant owes nothing further on medical bills that have been discounted or repriced. 1 Farmer-Cummings involved a claim that the employer was not entitled to a credit for a bill that was adjusted and asserted the employer owed the full amount without evidence that the liability had been extinguished. In cases of private insurance, some providers could arguably reconsider "write-offs" and elect to pursue further reimbursement. None of the reported Commission cases have directly addressed the reason under Farmer-Cummings why an employer must prove lack of further liability of medicaid paid bills, when as a matter of law the provider cannot pursue further benefits.2
Recent Commission decisions make no exception for medicaid: adjusted bills require evidence of liability limited to the repriced amount .3 Similarly, a hold harmless agreement does not absolve an employer from liability.4 Allowing claimant to testify they owe nothing has had mixed results.5 None of the cases have dealt directly with issues of judicial notice of the federal rule.6
In the cases of medicaid-bills, submission of a medicaid invoice alone should suffice to prove lack of liability, contrary to some recent decisions. To require testimony or affidavits from every medical provider can represent substantial costs. Cases such as Eichelberger7 express outrage that employers may punt medical liability, force a claimant to go on public-welfare medical, and then seek protection of reduced rates when providers take medicaid-reduced rates. Giving awards to claimants to protect them in case a doctor "might" pursue them for further charges contrary to the provider's own medicaid agreements serves no public purpose and furnishes a windfall as the bill has already been paid in full.
1. Farmer-Cummings v Personnel Pool of Platte County, 110 S.W.3d 818, 822-823 (Mo. Banc. 2003). See also Martin v Mid America Farm Lines, Inc., 769 S.W.2d 105 (Mo. Banc 1989), Jennings v Station Casino, DOLIR 4-10-07.
2. 42 CFR 447.17, Evanston Hosp. V. Hauck, 1 F. 3d 540, 542 (7th Circ. 1993).
3. Rector v Gary’s Heating, DOLIR 1-23-09 (medicaid bill), see also Wyatt v Blair Packaging, DOLIR 3-12-09 (no award for bills discharged in bankruptcy, no reduction for other adjusted charges), Dunn v Jordan Concrete, DOLIR 8-11-06 (EOB insufficient).
4. Bea v Irvinbilt Co., DOLIR 1-16-08.
5 Allen v Luthor Manor, DOLIR 7-24-04 (testimony allowed) Eichelberger v Gateway Preventatitve Dental Group, DOLIR 7-22-05 (testimony rejected)
6. Lattimore v Washington University, DOLIR 4-15-04, Jennings v Station Casino, DOLIR 4-10-07, Brock v Broadway Ford Sales 10-29-07
7. Eichelberger v Gateway Preventative Dental Group, DOLIR 7-22-05.