CostFirst settles for a “de minimus” amount by demonstrating that the lien claimant cannot meet their evidentiary burden of proof.
Hearing: Lien Conference 06/08/16, Honorable Andrew Shorenstein. SDO
The applicant underwent a left ankle surgery at La Jolla Orthopaedic Surgery Center on 02/18/2010. Said surgery was for left ankle arthrodesis with bone graft, subtalar arthrodesis with bone graft and tibial nailing, preparation of donor site with subsequent platelet sealant grafting and popliteal block. York paid La Jolla Orthopaedic Surgery Center for the procedure pursuant to the OMFS for outpatient hospital facility fee schedule.
Lien claimant Access Mediquip (Access) filed a lien in the amount of $13,772.00, for reimbursement of the implants allegedly used in said surgery. They presented an invoice that Access paid to Integra Lifesciences Corp. for various implantable hardware, nails, screws that were delivered to La Jolla Orthopaedic Surgery Center for said surgery. Access also presented an implant log showing that said nails and screws were indeed used in the above stated surgery. The lien was assigned to Pinnacle Lien Service who paid the lien fees.
After determining that the Lien Assignment was valid, CostFirst settled the lien for $100 to avoid further costs. The CostFirst Expert argued that the cost of implantable hardware should have been included in reimbursement to the surgery center. Lien claimant could not prove which hardware was actually used because the operative report was not part of the board file. Rather than face a continuance on the evidentiary issue, the lien was settled for nuisance value.
Since this was an OptiMix™ assignment, CostFirst appeared to defend at the conference; thus, defense attorney costs were avoided. Medical loss savings were $13,672 or 99%. The claim was closed in less than 30 days after assignment.