Another blow to third party billers
WorkingRx lost a court case in Utah recently, in yet another setback to the third party biller industry.
This comes on the heels of other successful legal challenges to WRx, which was recently acquired by its only real competitor - Third Party Solutions.
This most recent case has been working its way thru the legal process for quite some time. Specifically, this case dealt with jurisdiction, with WRx suing the Work Comp Fund of Utah (WCF) in district court for about $4 million for 'underpayments' for prescriptions processed by WRx. The suit was based on two claims - that WCF failed to pay "reasonable sums" for scripts, and a violation of due to 'unjust enrichment'.
The court upheld the lower court's dismissal of WRx's claim, ruling that the "trial court had "no jurisdiction whatsover" to rule on the claim."
While this may appear to be a rather narrow ruling, it represents another blow to the TPB industry, which has long attempted to broaden its legal attack against payers beyond Labor Commissions and other WC-specific adjudication entities. (for more, see this)
What does this mean for you?
This latest loss, coupled with other ongoing (and growing) business challenges for TPBs, strengthens the hands of payers as it requires TPBs to seek redress for their real and imagined claims via the WC legal process.
Thanks to a friend of Managed Care Matters for the heads up on this case. To obtain a soft copy of the ruling, email me at infoAThealthstrategyassocDOTcom.