MSP Recovery, Inc. d/b/a LifeWallet (NASDAQ: LIFW) ("LifeWallet,"
or the "Company"), a Medicare, Medicaid, commercial, and Secondary
Payer1 reimbursement recovery and technology leader, today
announced the Eleventh Judicial Circuit Court of Florida entered an
order memorializing its class certification2 in a case against USAA
Casualty Insurance Company and USAA General Indemnity Company
(collectively “USAA”), utilizing LifeWallet’s proprietary data
analytics system, extensive knowledge of the Medicare Secondary
Payer Act (“MSP Act”), and experience in healthcare reimbursement
recovery. The case directly benefits plaintiffs, which include: (1)
LifeWallet’s clients who assigned their claim rights to MSP
Recovery entities and any future assignor clients; as well as (2)
all Medicare Advantage Organizations (“MAO”), Medicaid Managed Care
Organizations (“MCO”), first-tier and downstream at risk entities,
and their assignees, that provided services on an at-risk basis in
the State of Florida to beneficiaries who were covered by USAA
under a Florida No-Fault Benefits policy, for which USAA under a
no-fault/personal injury protection(“PIP”) insurance policy had
primary coverage. The Court also entered an order approving class
notice, which was distributed to class members beginning June 10,
2024.
The Court noted during the evidentiary hearing that LifeWallet
and its team are, to the Court’s knowledge, “the only group that
could put this together with their proprietary system.”
LifeWallet developed a sophisticated data analytics system, that
in collaboration with Palantir Technologies Inc., captures and
manages data, demonstrating property and casualty insurer (“P&C
Insurer”) USAA’s failure to adequately coordinate benefits. This
system is an integral part of the evidence presented to the Court,
exemplifying the breadth and depth of the systemic issues plaguing
the healthcare system.
“LifeWallet utilizes its proprietary system to analyze data from
multiple sources, including civil litigation,” said LifeWallet
Founder and CEO, John H. Ruiz. “We employ I.T. personnel,
accountants, statisticians, physicians, data analysts, and
attorneys to identify when Primary Payers3 are responsible for
payment. Without the proper identification and notification, USAA
defendants and other Primary Payers could continue to evade their
primary payment obligations, leading to an ongoing cycle of
healthcare entities being unable to avoid paying costs they are not
responsible for,” Ruiz said.
The case, brought by MSP Recovery Law Firm on behalf of MSP
Recovery Claims, Series LLC and MSPA Claims 1, LLC, centers on
allegations that USAA’s inaction contravenes both state and federal
laws. This systemic and class-wide failure to identify benefits,
Plaintiffs assert, has caused and will continue to cause
Plaintiffs, and all similarly situated MAOs, MCOs, at-risk
first-tier and downstream entities, and their assignees, throughout
the state of Florida (the “Class”), to pay for accident-related
medical items and services for which USAA has a primary obligation
to pay.
As noted in today’s order granting Plaintiffs’ motion for class
certification:
“USAA’s failure to comply with its
duties under Section 627.736(4), Florida Statutes and the resulting
harm to Class Members now and in the future can be demonstrated
with evidence provided by Plaintiffs’ MSP System to identify
specific instances of Defendant’s failure to coordinate
benefits.”
“This problem is exacerbated by what
the MSP Recovery Entities have learned about the insurance
industry; namely, that insurers have made a deliberate business
decision to do nothing to identify and reimburse secondary payments
and sit on their hands until (and after) they are sued. The MSP
System exposes this business decision by matching beneficiaries and
assignor payments with third-party databases. However, Defendant’s
failure to provide the information prevents the Plaintiffs from
confirming the full scope of Defendant’s liability….”
“The MSP System captures data from
different sources to identify the Class Members’ insureds’ medical
expenses incurred as a result of an automobile accident and which
should have been paid for by Defendant. Specifically, the system
analyzes: Defendant’s data on whether it insured a particular Class
Member’s insured; Defendant’s reporting data indicating their
primary payer obligation for a Medicare beneficiary’s medical
expenses; Defendant’s data as to whether it reimbursed secondary
payments; Plaintiffs’ data as to what payments its assignors made
for Defendant’s insureds; and Class Members’ data as to what
secondary payments they made for Defendant’s insureds.”
Ruiz, who also argued on behalf of the Plaintiffs as lead
counsel for MSP Recovery Law Firm during the certification hearing,
quoted the deposition testimony of USAA’s corporate
representatives, revealing significant insights into the company's
practices. One corporate representative admitted, “Adjusters do not
ask” about Medicare Advantage coverage, highlighting a systemic
issue within USAA's processes. Another representative acknowledged,
“There is no process currently to reach out” to the health plan for
claims related to the underlying claim, which underscores USAA's
failure to coordinate benefits properly with Medicare Advantage
organizations.
The Court also issued an order to show cause as to why USAA’s
counsel should not be held in contempt, lack of candor to the
tribunal as alleged by Plaintiffs. The order set a hearing for June
28, 2024, requiring opposing counsel to show cause as to why it
should not be sanctioned for the substantial alleged
misrepresentations made by USAA’s counsel to the Court during the
certification hearing and delineated by Plaintiffs’ motion.
MSP Recovery Inc., and its affiliates also have
11 motions for class certification pending in the Circuit Court of
the Eleventh Judicial Circuit in Miami-Dade County, Florida against
41 other insurance companies on the same grounds. Those companies
include: Ace Property and Casualty Insurance Company, Ace Insurance
Company of The Midwest, Ace Fire Underwriters Insurance Company,
Ace American Insurance Company, MGA Insurance Company, Inc.,
Ascendant Commercial Insurance, Inc., Progressive Advanced
Insurance Company, Progressive American Insurance Company,
Progressive Bayside Insurance Company, Progressive Casualty
Insurance Company, Progressive Direct Insurance Company,
Progressive Express Insurance Company, Progressive Select Insurance
Company, Progressive Southeastern Insurance Company, Progressive
Specialty Insurance Company, First Acceptance Insurance Company,
Inc., Liberty Mutual Mid-Atlantic Insurance Company, Liberty Mutual
Fire Insurance Company, Liberty Mutual Insurance Company, Safeco
Insurance Company of America, Safeco Insurance Company of Illinois,
Safeco National Insurance Company, Hartford Accident and Indemnity
Company, Hartford Casualty Insurance Company, Hartford Fire
Insurance Company, Hartford Insurance Company of The Midwest,
Hartford Insurance Company of The Southeast, Hartford Underwriters
Insurance Company, Property & Casualty Insurance Company of
Hartford, The Travelers Casualty Company, The Travelers Indemnity
Company of Connecticut, The Travelers Indemnity Company, The
Travelers Indemnity Company Of America, Travelers Casualty and
Surety Company, Travelers Property Casualty Company Of America,
Travelers Property Casualty Insurance Company, Star Casualty
Insurance Company, Mercury Insurance Company of Florida, Mercury
Indemnity Company of America, Mercury Casualty Company, and
American Mercury Insurance Company.
Recent SettlementsThis court decision comes
after LifeWallet’s most successful quarter to date since becoming a
publicly traded company, achieving two previously announced
comprehensive settlements with multiple P&C insurers.
LifeWallet believes these settlements can establish a process to
collaboratively and timely resolve future claims that are owed to
LifeWallet from the Company’s portfolio of assigned claims. Through
collaborative data sharing, LifeWallet believes these settlements
can provide additional data that enhances its ability to identify
the parties responsible for unreimbursed medical liens owned by
LifeWallet. It also allows LifeWallet to identify any recoverable
claims for future business that pertain to the settling
counterparties.
LifeWallet continues making progress with settlement
negotiations involving other P&C Insurers to resolve pending
litigation under the same or similar framework. LifeWallet’s goal
is to bring additional P&C Insurers into a similar settlement
structure, building a potential revenue stream that is diversified
and predictable.
Forward Looking Statements
This press release contains forward-looking statements within
the meaning of the federal securities laws. Forward-looking
statements may generally be identified by the use of words such as
“anticipate,” “believe,” “expect,” “intend,” “plan" and “will” or,
in each case, their negative, or other variations or comparable
terminology. These forward-looking statements include all matters
that are not historical facts, including for example statements
regarding potential future settlements. By their nature,
forward-looking statements involve risks and uncertainties because
they relate to events and depend on circumstances that may or may
not occur in the future. As a result, these statements are not
guarantees of future performance or results and actual events may
differ materially from those expressed in or suggested by the
forward-looking statements. Any forward-looking statement made by
the Company herein speaks only as of the date made. New risks and
uncertainties come up from time to time, and it is impossible for
the Company to predict or identify all such events or how they may
affect it. the Company has no obligation, and does not intend, to
update any forward-looking statements after the date hereof, except
as required by federal securities laws. Factors that could cause
these differences include, but are not limited to, the Company’s
ability to capitalize on its assignment agreements and recover
monies that were paid by the assignors; the inherent uncertainty
surrounding settlement negotiations and/or litigation, including
with respect to both the amount and timing of any such results; the
success of the Company's scheduled settlement mediations; the
validity of the assignments of claims to the Company; negative
publicity concerning healthcare data analytics and payment
accuracy; and those other factors included in the Company’s Annual
Report on Form 10-K, Quarterly Reports on Form 10-Q and other
reports filed by it with the SEC. These statements constitute the
Company’s cautionary statements under the Private Securities
Litigation Reform Act of 1995.
About LifeWalletFounded in 2014 as MSP
Recovery, LifeWallet has become a Medicare, Medicaid, commercial,
and secondary payer reimbursement recovery leader, disrupting the
antiquated healthcare reimbursement system with data-driven
solutions to secure recoveries from responsible parties. LifeWallet
innovates technologies and provides comprehensive solutions for
multiple industries including healthcare, legal, and sports NIL.
For more information, visit: LIFEWALLET.COM
Contact
Media:ICR, Inc.LifeWallet@icrinc.com
Investors:Investors@LifeWallet.com
1 “Secondary Payers” includes Medicare Part C plans, as well as
downstream entities. MSP Recovery Claims, Series LLC v. ACE Am.
Ins. Co., 974 F.3d 1305, 1316 (11th Cir. 2020).2 The case is MSP
Recovery Claims Series LLC et al. v. USAA Casualty Insurance
Company, No. 2018-042110-CA-01 (Fla. 11th Cir. Ct. filed Dec. 19,
2018).3 “Primary Plans” or “Primary Payers,” when used in the
Medicare Secondary Payer context, means “any entity that is or was
required or responsible to make payment with respect to an item or
service (or any portion thereof) under a primary plan. These
entities include, but are not limited to, insurers or
self-insurers, third party administrators, and all employers that
sponsor or contribute to group health plans or large group health
plans.” 42 C.F.R. § 411.21.
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