Rathbun v. Health Net of the Northeast, Inc.

CourtSupreme Court of Connecticut
DecidedMarch 10, 2015
DocketSC18928
StatusPublished

This text of Rathbun v. Health Net of the Northeast, Inc. (Rathbun v. Health Net of the Northeast, Inc.) is published on Counsel Stack Legal Research, covering Supreme Court of Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rathbun v. Health Net of the Northeast, Inc., (Colo. 2015).

Opinion

****************************************************** The ‘‘officially released’’ date that appears near the beginning of each opinion is the date the opinion will be published in the Connecticut Law Journal or the date it was released as a slip opinion. The operative date for the beginning of all time periods for filing postopinion motions and petitions for certification is the ‘‘officially released’’ date appearing in the opinion. In no event will any such motions be accepted before the ‘‘officially released’’ date. All opinions are subject to modification and technical correction prior to official publication in the Connecti- cut Reports and Connecticut Appellate Reports. In the event of discrepancies between the electronic version of an opinion and the print version appearing in the Connecticut Law Journal and subsequently in the Con- necticut Reports or Connecticut Appellate Reports, the latest print version is to be considered authoritative. The syllabus and procedural history accompanying the opinion as it appears on the Commission on Official Legal Publications Electronic Bulletin Board Service and in the Connecticut Law Journal and bound volumes of official reports are copyrighted by the Secretary of the State, State of Connecticut, and may not be repro- duced and distributed without the express written per- mission of the Commission on Official Legal Publications, Judicial Branch, State of Connecticut. ****************************************************** AMY RATHBUN ET AL. v. HEALTH NET OF THE NORTHEAST, INC. (SC 18928) Palmer, Zarella, McDonald, Espinosa and Vertefeuille, Js. Argued September 25, 2014—officially released March 10, 2015

Eric P. Smith, with whom, on the brief, were John P. D’Ambrosio and Joel T. Faxon, for the appellants (plaintiffs). Linda L. Morkan, with whom, on the brief, was Theo- dore J. Tucci, for the appellee (defendant). Opinion

PALMER, J. The issue that we must resolve in this certified appeal is whether General Statutes § 17b-265 (a),1 which provides in relevant part that the Depart- ment of Social Services (department) ‘‘shall be subro- gated to any right of recovery . . . that an applicant or recipient of medical assistance . . . has against an insurer or other legally liable third party . . . that is . . . legally responsible for payment of a claim for a health care item or service,’’ authorizes the department or its designated assignee to seek reimbursement from a Medicaid recipient for medical costs that the recipient has recovered from a liable third party. After the named plaintiff, Amy Rathbun, and the daughter of the plaintiff Tanequa Brayboy were injured in separate motor vehi- cle accidents, the defendant, Health Net of the North- east, Inc. (Health Net), which administered the Medi- caid program for the state of Connecticut and was the designated assignee of the department’s rights under § 17b-265, paid for medical care that Brayboy’s daughter and Rathbun received as a result of their injuries. Both plaintiffs brought civil actions against the persons who had caused the injuries. Thereafter, pursuant to § 17b- 265, Health Net, acting through its agent, The Rawlings Company, LLC (Rawlings), sought to recover from the plaintiffs amounts that the plaintiffs had recovered from the respective tortfeasors as reimbursement for the pay- ments made by Health Net for the medical care provided to Brayboy’s daughter and Rathbun. The plaintiffs then brought this action seeking, among other things, a declaratory judgment that § 17b-265 (a) does not autho- rize Health Net to seek reimbursement from them but requires it to seek recovery directly from the liable third parties. Both the plaintiffs and Health Net filed motions for summary judgment as to the declaratory judgment count, and the trial court granted Health Net’s motion and denied the plaintiffs’ motion. After the plaintiffs withdrew the remaining counts of their complaint, and the trial court rendered judgment for Health Net, the plaintiffs appealed to the Appellate Court, which affirmed the trial court’s judgment. Rathbun v. Health Net of the Northeast, Inc., 133 Conn. App. 202, 215, 35 A.3d 320 (2012). We then granted the plaintiffs’ petition for certification to appeal, limited to the following issue: ‘‘Did the Appellate Court properly conclude that . . . § 17b-265 permitted [Health Net] to bring an action against the plaintiffs to recover its collateral source payments?’’ Rathbun v. Health Net of the Northeast, Inc., 304 Conn. 905, 38 A.3d 1201 (2012). We answer the certified question in the affirmative and, therefore, affirm the judgment of the Appellate Court. The opinion of the Appellate Court sets forth the following procedural history and facts, which were stip- ulated to by the parties and accepted by the trial court. ‘‘Under the Medicaid Act (Medicaid); 42 U.S.C. § 1396 et seq. [2012]; federal financial assistance is provided to states that choose to reimburse the costs of medical care to the economically disadvantaged. States may choose contractors to provide or to arrange for services under the state Medicaid plan, which is known as Medi- caid managed care. The state of Connecticut partici- pates in the Medicaid program and has authorized the department . . . to administer the program within the state. The department is authorized to award ‘contracts for Medicaid managed care health plans’ under General Statutes § 17b-28b. ‘‘The department contracted with [Health Net] directly and through its predecessors from 1995 through 2008 regarding the administration of the Medicaid man- aged care program. The contract provided that ‘[t]he [d]epartment hereby assigns to [Health Net] all rights to third party recoveries from Medicare, health insurance, casualty insurance, workers’ compensation, tortfea- sors, or any other third parties who may be responsible for payment of medical costs for [Health Net’s] mem- bers.’ The contract limited [Health Net’s] right to recov- ery to the amount that [it] paid toward the cost of its member’s care. The contract required [Health Net] to make efforts to determine the legal liability of third parties for health care services provided to Medicaid enrollees, and to ‘pursue, collect, and retain any [money] from [third-party] payers for services to [Health Net’s] members under this contract . . . .’ The contract further provided that [Health Net] could assign ‘the right of recovery to [its] subcontractors and/or net- work providers.’ ‘‘[Health Net] contracted with [Rawlings] . . . to pursue recoveries for medical treatment provided to [Health Net’s] members in instances [in which] there was potential for [third-party] liability. When Rawlings became aware that a member was injured by a third party, it typically notified the injured member and the third party that [Health Net] had a right to recover medical expenses paid on the member’s behalf. ‘‘Rathbun was a member of [Health Net’s] Medicaid managed care plan. [Health Net] paid $2982.93 for medi- cal treatment [rendered in connection with] Rathbun’s injuries stemming from a motor vehicle accident that occurred on July 24, 2006. Rathbun retained legal coun- sel to pursue potential tort claims against the driver of the other vehicle involved in the accident. Rawlings notified Rathbun’s counsel, as well as the [driver’s] insurer, that [Health Net] had a claim for repayment of the medical benefits it [had] paid on Rathbun’s behalf for injuries sustained in the motor vehicle accident. Rathbun’s counsel sent a check in the amount of $2982.93 to [Health Net] in satisfaction of [Health Net’s] claim.

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Rathbun v. Health Net of the Northeast, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/rathbun-v-health-net-of-the-northeast-inc-conn-2015.