Filed: May 02, 2014
Latest Update: May 02, 2014
Summary: NOT DESIGNATED FOR PUBLICATION CRAIN, J. In this suit seeking to recover an overpayment of medical benefits, the workers' compensation judge (WCJ) granted an exception of prescription and dismissed the claim with prejudice. We reverse the WCJ's judgment, deny the exception, and remand for further proceedings. FACTS AND PROCEDURAL HISTORY Winn-Dixie Louisiana filed a "Disputed Claim for Compensation" on October 29, 2012, against HCA Management Services, L.P., alleging that Winn-Dixie made an
Summary: NOT DESIGNATED FOR PUBLICATION CRAIN, J. In this suit seeking to recover an overpayment of medical benefits, the workers' compensation judge (WCJ) granted an exception of prescription and dismissed the claim with prejudice. We reverse the WCJ's judgment, deny the exception, and remand for further proceedings. FACTS AND PROCEDURAL HISTORY Winn-Dixie Louisiana filed a "Disputed Claim for Compensation" on October 29, 2012, against HCA Management Services, L.P., alleging that Winn-Dixie made an e..
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NOT DESIGNATED FOR PUBLICATION
CRAIN, J.
In this suit seeking to recover an overpayment of medical benefits, the workers' compensation judge (WCJ) granted an exception of prescription and dismissed the claim with prejudice. We reverse the WCJ's judgment, deny the exception, and remand for further proceedings.
FACTS AND PROCEDURAL HISTORY
Winn-Dixie Louisiana filed a "Disputed Claim for Compensation" on October 29, 2012, against HCA Management Services, L.P., alleging that Winn-Dixie made an erroneous overpayment of medical benefits to HCA for treatment rendered to a Winn-Dixie employee from April 22, 2005 through April 28, 2005. According to the claim, Winn-Dixie paid HCA (through Lakeview Regional Medical Center) the sum of $46,082.19 for the treatment, but the payment should have been $12,378.00 under the Louisiana Inpatient Reimbursement Schedule.1 Consequently, Winn-Dixie sought reimbursement from HCA for the alleged overpayment of $33,704.19.
HCA responded with an exception of prescription in reliance upon Louisiana Revised Statute 23:1209C, which provides:
All claims for medical benefits payable pursuant to R.S. 23:1203 [setting forth an employer's duty to pay medical benefits for an injured employee] shall be forever barred unless within one year after the accident or death the parties have agreed upon the payments to be made under this Chapter, or unless within one year after the accident a formal claim has been filed with the office as provided in this Chapter. Where such payments have been made in any case, this limitation shall not take effect until the expiration of three years from the time of making the last payment of medical benefits.
HCA argued that Winn-Dixie's claim sought recovery of "medical benefits" and was subject to the prescriptive periods set forth in Section 1209C. In support of the exception, HCA introduced an affidavit and billing records which established that Winn-Dixie's payment was made in two installments on August 3, 2005, and September 29, 2005, approximately seven years prior to the filing of the claim. Therefore, according to HCA, the claim was filed over four years too late and should be dismissed on the basis of prescription.
Winn-Dixie countered that its claim was an action to recover an erroneous overpayment made to a healthcare provider and was not a claim filed by an employee or healthcare provider for medical benefits payable under Louisiana Revised Statute 23:1203. Therefore, according to Winn-Dixie, the claim was not governed by Section 1209C and, instead, was subject to the general prescriptive period of ten years set forth in Louisiana Civil Code article 3499.
At the conclusion of the hearing on the matter, the WCJ sustained the exception of prescription and dismissed the claim with prejudice. A judgment was signed in accordance with the ruling, and Winn-Dixie appealed.
LAW AND ANALYSIS
The determinative issue in this appeal is whether Section 23:1209C applies to a claim filed by an employer seeking recovery of an alleged overpayment of medical benefits made to a healthcare provider. The Louisiana Supreme Court recently considered this issue and held:
By its terms, La. R.S. 23:1209(C) sets forth the prescriptive period for "claims for medical benefits payable pursuant to R.S. 23:1203." La. R.S. 23:1203 addresses the employer's obligation to provide medical care and services to an injured employee. On its face, Winn-Dixie's claim for recovery of an overpayment is not a claim for "medical benefits payable pursuant to R.S. 23:1203."
We further find this conclusion is supported by the case law interpreting La. R.S. 23:1209. While this precise issue presented in the case at bar is res nova, the jurisprudence has long recognized that the purpose of La. R.S. 23:1209 is to protect the employer from stale claims by the employee. . . . Clearly, this purpose is not served by applying the statute to a claim made by the employer against a medical provider for overpayment. Therefore, we find La. R.S. 23:1209 is inapplicable in this context.
Having found La. R.S. 23:1209 does not apply to the instant case, we are unable to find any other specific prescriptive provisions of the Workers' Compensation Law which would govern this dispute. Therefore, we find the applicable prescriptive period is the general ten-year prescription set forth in La. Civ. Code art. 3499. . . .
Applying the ten-year prescriptive period, it is clear Winn-Dixie's claim is timely. Accordingly, we must reverse the judgment of the court of appeal, deny the exception of prescription, and remand the case to the OWC for further proceedings.
Winn-Dixie Louisiana v. Physicians Surgical Specialty Hospital, 13-2680, pp. 3-4 (La. 2/21/14), ___ So.3d ___, ___ (per curiam) (citations omitted).
In accordance with the supreme court's holding in Winn-Dixie Louisiana, Winn-Dixie's claim against HCA seeking recovery of an alleged overpayment of medical benefits is governed by the ten-year prescriptive period set forth in Louisiana Civil Code article 3499 and, therefore, was timely filed.
CONCLUSION
We reverse the June 12, 2013 judgment sustaining the exception of prescription, overrule the exception, and remand the case for further proceedings. All costs of this appeal are assessed to HCA Management Services, L.P.
REVERSED, EXCEPTION OF PRESCRIPTION OVERRULED, AND REMANDED.
