Roemen v. United States of America

District Court, D. South Dakota·Decided November 8, 2023·No. 4:19-cv-04006·Unknown

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF SOUTH DAKOTA SOUTHERN DIVISION

MICAH ROEMEN, and TOM TEN EYCK, 4:19-CV-4006-LLP Guardian of Morgan Ten Eyck; and MICHELLE TEN EYCK, Guardian of Morgan Ten Eyck, MEMORANDUM OPINION AND ORDER GRANTING IN PART AND DENYING IN Plaintiffs, PART PLAINTIFFS’ MOTION IN LIMINE 3 VS.

UNITED STATES OF AMERICA, ROBERT . _NEUENFELDT, individually and UNKNOWN SUPERVISORY PERSONNEL OF THE UNITED STATES, individually,

Defendants.

“Pending before the Court is Plaintiffs’ Motion in Limine 3 to exclude under the collateral "source rule any evidence that Plaintiffs had health insurance at the time of the accident or received _ benefits from such health insurance. (Doc. 207). The Government has filed a response to Plaintiffs’ Motion (Doc. 218) and Plaintiffs have filed their reply (Doc. 221). In their response, the Government provides that Morgan Ten Eyck receives TRICARE coverage through her father, Tom Ten Eyck, who has been an enlisted member of the military since 1988. (Doc. 218 at 4721). Morgan is enrolled in TRICARE as an “adult dependent” under Mr. Ten Eyck’s TRICARE. The Government argues that TRICARE is not a collateral source and the United States is entitled to an offset against any FTCA damage award for past TRICARE payments to third-party medical □ providers, as well as for the cost of future care that likely will be paid by the government through TRICARE. (Doc. 218 at 4716). BACKGROUND

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Pursuant to authority delegated to it by Congress, the Department of Defense established the Civilian Health and Medical Program of the Uniformed Services, called CHAMPUS, in 1967. Baptist Physician Hosp. Org., Inc. v. Humana Military Healthcare Servs., Inc., 368 F.3d 894, 895 (6th Cir. 2004). CHAMPUS beneficiaries include retired armed forces personnel and dependents of both active and retired military personnel. Jd) CHAMPUS is funded from the U.S. Treasury by moneys appropriated by Congress in the annual Defense Appropriations Act. Kornegay v. United States, 929 F.Supp. 219, 221 (E.D. Va. 1996) (citing 32 C.F.R. 191(d), (e)). In 1995, the Department of Defense established TRICARE, a managed health care program operating as a supplement to CHAMPUS and involving the competitive selection of private contractors to financially underwrite the delivery of health care services under CHAMPUS. Baptist Physician Hosp. Org, 368 F.3d at 895. There are various types of TRICARE benefit programs. See 32 C.F.R. § 199.17(a)(6)(ii) (listing “TRICARE Prime,” “TRICARE Select,” “TRICARE for Life,” and “TRICARE Standard”), The Government states that as an enlisted member of the military, Mr. Ten Eyck is enrolled in “TRICARE Reserve Select” and that his daughter Morgan Ten Eyck is enrolled in TRICARE through her father as an “adult dependent.” (Doc. 218 at 4721-22). The Government contends that Morgan’s TRICARE benefits would, like CHAMPUS, be funded from the general treasury of the United States. TRICARE Reserve Select is a premium-based health plan that is available for purchase by members of the Selected Reserve and certain survivors of Selected Reserve members. 32 C.F.R. § 199.24(a)(1). TRICARE Reserve Select offers the TRICARE Select self-managed, preferred- provider network option under § 199.17 to qualified members of the Selected Reserve, their immediate family members, and qualified survivors. 32 C.F.R. § 199.24(a). TRICARE Select allows beneficiaries to use the TRICARE provider civilian network, with reduced out-of-pocket costs compared to care from non-network providers, as well as military treatment facilities (where they exist and when space is available). 32 C.F.R. 199.17(a)(6)(i)(B). TRICARE Select enrollees do not have restrictions on their freedom of choice with respect to authorized health care providers. Id. However, when a TRICARE Select beneficiary receives services covered under the basic . program from an authorized health care provider who is not part of the TRICARE provider network that care is covered by TRICARE but is subject to higher cost sharing amounts for “out- of-network” care. Id. TRICARE Reserve Select features the deductible, catastrophic cap and cost

share provisions of the TRICARE Select plan applicable to Group B active duty family members under § 199.17(1)(2)(ii) for both the member and the member’s covered family members; however, the TRICARE Reserve Select premium applies instead of any TRICARE Select plan enrollment fee under § 199.17. 32 CER. § 199.24(a)(4)(iv). A retiree or retiree family member who becomes eligible for Medicare Part A is not eligible to enroll in TRICARE Select. 32 C.F.R. § 199.17(c). In general, when a retiree or retiree family member becomes individually eligible for Medicare Part A and enrolls in Medicare Part B, he/she is automatically eligible for TRICARE-for-Life and is required to enroll in the Defense Enrollment Eligibility Reporting System to verify eligibility. Jd TRICARE-for-Life is the Medicare wraparound coverage plan under 10 U.S.C. § 1086(d). 32 C.F.R. 199.17(a)(6)(ii)(C). A retiree must purchase Medicare Part B to be eligible for the Tricare-for-Life medical benefit. 10 U.S.C. § 1086(d)(1), (2); Brown v. United States, Civ. No. 3:17-551, 2020 WL 6811121, at *10 (S.D. Miss. May 13, 2020). A retiree pays a monthly fee—deducted from his or her monthly Social Security payment—for Medicare Part B. See Schism v. United States, 316 F.3d 1259, 1265 (Fed. Cir. 2022). Tricare-for-Life covers out-of-pocket costs for care greater than that covered by Medicare and amounts paid or payable by third party payers other than Medicare. 10 U.S.C. § 1086(d)(3)(A). DISCUSSION The Government argues that in the event the Court finds that Plaintiffs are entitled to an FTCA damages award against the United States, Plaintiffs’ past and future medical expenses should be offset by the amount of medical expenses paid by the United States through TRICARE. (Doc. 218). The Government argues that TRICARE payments are an exception to the collateral source rule. Under South Dakota law, “total or partial compensation received by an injured party from a collateral source, wholly independent of the wrongdoer, does not operate to reduce the damages recoverable from the wrongdoer.” Papke v. Harbert, 738 N.W.2d 510, 531 (S.D. 2007). The Government argues that TRICARE benefits are funded from the general treasury of the United States to which the recipients of TRICARE benefits do not contribute. (Doc. 218 at 4719-20). The Government argues that because the source of TRICARE funds are not “wholly independent of the wrongdoer,” the United States in this case, the offsetting of past and future medical payments is necessary in order to ensure that the United States is not paying twice for the same injury. (Doc. 218 at 4717).

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