There has never been a more complicated time than now to be a healthcare payer or plan. Costs and complications are continuing to increase. Rising healthcare expenses result in reduced benefits and higher costs for plan participants. High cost medical expenses resulting from defective medical devices, dangerous pharmaceuticals, and toxic chemicals are unfortunately often overlooked – at great cost – by traditional methods and models, which fail to identify and recover mass tort recovery opportunities effectively. Healthcare payers and plans relinquish recovery rights when they fail to effectively and proactively pursue these mass tort recovery opportunities.
Currently, many healthcare payers and plans have maximized their recovery of medical expenses that result from automobile, premises, and workplace accidents. These “subrogation” models have long been an important component of the cost containment puzzle. However, those approaches are no longer sufficient and are leaving behind millions in paid mass tort medical expenses. Today’s healthcare payers and plans must look to areas like mass tort, when numerous plaintiffs sue one defendant, to meet the growing pressure to assist payers contain costs while not relinquishing recovery rights for healthcare payers and plans.
In fact, it’s often the most complex and expensive medical expenses that were caused by unsafe prescription drugs, defective medical devices, and toxic chemicals. These unjustly increase healthcare expenditures and should not be absorbed by the healthcare payer or plan. Healthcare Recovery Solutions uses patented systems and technology and payers’ own claims data to maximize mass tort recoveries.
Few healthcare payers and plans have the expertise or resources necessary to identify and pursue these complex and costly forms of medical expenses. Healthcare Recovery Solutions’ patented mass tort cost containment and recovery software enable healthcare payers and plans to greatly expand upon their existing cost containment recovery opportunities. Our platform is currently being utilized not only by healthcare payers and plans, but also some of the industry leaders in cost containment and subrogation recovery in the United States. Our systems may also be integrated within a healthcare payers own environment.
Healthcare Recovery Solutions’ state-of-the-art and proprietary mass tort cost containment platform empowers healthcare payers and plans to better identify high-cost recovery opportunities related to mass torts and fraud, waste and abuse with no upfront costs. The data is right there. Our technology puts it to work.
Healthcare Recovery Solutions’ mass tort cost containment and recovery platforms enable healthcare payers and plans to recover medical expenses for treatment related to defective medical devices, dangerous pharmaceuticals, and toxic chemicals. Mass tort – numerous individuals pursuing litigation against a manufacturer – medical expenses are often much higher than medical expenses associated with automobile, premises, workplace, and other types of accidents. This is just one reason why Healthcare Recovery Solutions is one of the most important pieces of the healthcare cost containment puzzle.
Yet, healthcare payers and plans typically lack the necessary tools to identify and pursue recoveries caused by dangerous drugs, medical devices, and toxic chemicals, or fraud, waste, and abuse. Mass tort cost containment frequently provides significant medical expense recovery opportunities. Healthcare Recovery Solutions has the mass tort tools healthcare payers and plans need to succeed in some of their most costly recovery efforts. We pride ourselves and our success on our ability to focus only on mass tort recovery opportunities for our clients.
Health benefits plans provided by employers and unions frequently contain a right of subrogation for mass tort recoveries. This right enables a plan to recover medical expenses given to an employee or participant if the employee has received a personal injury recovery from a third-party. These subrogation provisions and the rights afforded to health benefit plans provided by employers and unions, are based on the Employee Retirement Income Security Act, 29 U.S.C. § 1001, et seq. (“ERISA”). By identifying mass tort recovery opportunities through Healthcare Recovery Solutions’ patented cost containment and recovery platforms, self-funded health care plans may be positioned to improve upon their recoveries related to medical expenses caused by dangerous pharmaceuticals, defective medical devices, toxic chemicals and fraud, waste, and abuse.
Healthcare plans that are funded by insurance companies may be subject to state laws that regulate the industry. If a plan is funded through insurance purchased by an employer or union, it will be treated as any other group health insurer for determining whether a subrogation claim is enforceable. State laws that regulate insurance and may limit a fully-insured plan’s recovery rights include the made-whole doctrine, the common fund doctrine, and anti-subrogation statutes. Many states provide good subrogation rights for fully-insured plans. Although non-ERISA plans do not enjoy the benefit of the ERISA (Employee Retirement Income Security Act, 29 U.S.C. § 1001, et seq.) preemption and may be subject to state laws, there remains significant mass tort recovery opportunities through the utilization of Healthcare Recovery Solutions’ patented cost containment platforms to identify and recover medical expenses for fully insured plans.
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