Manatee County Government Administrative Center Commission Chambers, First Floor 9:00 a.m. - February 25, 2014
REVISED February 25, 2014 - Regular Meeting
Agenda Item #22

Third Party Settlement Claims Agreement


Contact and/or Presenter Information
Christine L. Bowling, EMS Business Operations Manager, ext. 7874, and Ronald J. Koper, Jr, Director, Public Safety, ext. 3563.

Action Requested
Approval of Third Party Settlement Claims Agreement, authorizing PerSe Technology Services, Inc. (PST) to work with their contracted firm to recoup Manatee County EMS class action settlement funds.

Enabling/Regulating Authority
Florida Statute Chapter 401.

Background Discussion

On August 30, 2013, the U.S. District Court, District of New Jersey,  granted preliminary approval of  $120 million settlement for Aetna’s use of the Ingenix Database.  This is the second settlement stemming from allegations the Ingenix Database was faulty, resulting in inappropriate reimbursement for out-of-network services.

Any provider or group who furnished out-of-network services or supplies to Aetna from March 1, 2001, through August 30, 2013, may be eligible to receive settlement funds. To collect the additional reimbursement from the settlement fund, providers must submit documentation to the court approved Settlement Administrator before March 28, 2014.

Due to the complexity of the issue, the settlement has allocated a portion of the fund to reimburse the service providers for their losses. This means the providers who collect under the fund are not required to reimburse the patient.

Manatee County Emergency Services' billing provider, PerSe Technologies, Inc., a division of McKesson Business Performance Services, is working with the settlement experts at Managed Care Advisory Group (MCAG) to help collect the necessary information, perform an analysis, and submit all the documentation to the Settlement Administrator by the filing deadline.

The attached Third Party Settlement Claims Agreement will allow McKesson to release the claims Aetna processed to MCAG to review, file, and collect the out-of-network funds that were inappropriately paid in prior years.  MCAG will charge fifteen percent of the gross collections.  This process simplifies data collection, filing documents with the Settlement Administrators, and helps ensure Manatee County EMS is collecting as many settlement dollars as possible without the administrative burden.

County Attorney Review
Other (Requires explanation in field below)

Explanation of Other
RLS 14-009, Aetna Settlement Research.

Reviewing Attorney

Instructions to Board Records
Copies of approved agenda to: ron.koper@mymanatee.org, christine.bowling@mymanatee.org, and mauricio.chavez@mckesson.com

Cost and Funds Source Account Number and Name

Amount and Frequency of Recurring Costs

Attachment:  Cooney Approval 011014.pdf
Attachment:  Client Aetna Settlement Notice -Final_1 3 14.pdf
Attachment:  Aetna UCR LItigation Notice.pdf
Attachment:  Insurance Settlement Agreement Final Manatee for signature 021414.pdf