Saturday, May 20, 2023

COVID Claims under COVID Law: Labs Might Not Have "Privately Enforceable" Right to Payment

[As a non-attorney, I can't distinguish the issues, but FYI, a SCOTUS case with a large majority found, in June, that certain private rights to sue under Medicaid law, were valid - here.  The lab case in the original blog below, remains of equal interest.)



Everyone in the lab industry is aware that early Congressional acts during the COVID crisis created a requirement that insurers cover COVID testing without a copay.   Another clause in early COVID law stated that the payable rate, absent other contracting, was the lab's website public rate.  


A really interesting court case was mentioned in the May 8 issue of DARK REPORT (subscription).  A lab, GENESIS, is in dispute with private payors over its special legal right to COVID payments (federal district court, NJ).   Judge Evelyn Padin has ruled that while COVID laws created such payment rules for COVID testing, there was no "privately enforceable" right to payment included in the law.  (As such, only the feds would be able to enforce lagging payments to an unpaid lab).   


In addition, the legal case (here) quotes opinions that COVID laws only amended (by implication) ERISA law, and restrictions against ERISA lawsuits continue to apply. 


Found this interesting and was happy to find the legal decision online at  I'm not an attorney but it made me muse on whether other obligations, like private payers covering USPTF-endorsed preventive services, had or did not have a "private right to action" as perceived narrowly by Judge Padin in this developing area of law.


The case is GENESIS LABORATORY MANAGEMENT LLC, Plaintiff, v. UNITED HEALTH GROUP, INC. et al. Defendants, and has articles and additional filings and motions at Lexis (and here).