Here’s the problem: In the managed care litigation space, noncontracted medical providers are suing payors as part of their business-collections strategy, utilizing quasi-contract theories of recovery in their attempt to justify ever growing bills.
In the traditional contracted-provider/ payor relationship, the network agreement, of course, governs rates of reimbursement. Medical providers are turning to quasi-contract claims with frequency, however, when there is no contract between the payor (or managed care provider or defendant) and provider, or a contract contains an anti-assignment provision.
Today, payors are seeing more claims for unjust enrichment and quantum meruit — which translates to “as much as is deserved” — as providers scramble to secure payment for services (whether or not those services were requested by a payor).
In part, this is because the laws permitting recovery in the managed care space are unclear in certain areas of the country. This considered, payors can and should challenge these claims at the outset, and are not without their legal defenses.
Read the full article in Law360 here.