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LifeWallet Announces a Comprehensive Settlement With 28 Affiliated Property and Casualty Insurers, Benefiting LifeWallet's Medicare Clients Across the U.S.

LifeWallet Announces a Comprehensive Settlement With 28 Affiliated Property and Casualty Insurers, Benefiting LifeWallet's Medicare Clients Across the U.S.

LifeWallet宣佈與28家附屬財產和意外傷害保險公司達成全面和解,使LifeWallet在美國的醫療保險客戶受益。
GlobeNewswire ·  03/04 10:47

CORAL GABLES, Fla., March 03, 2024 (GLOBE NEWSWIRE) -- Coral Gables, FL, March 3, 2024. MSP Recovery, Inc. d/b/a LifeWallet (NASDAQ: LIFW) ("LifeWallet" or "the Company") announces a comprehensive settlement with 28 affiliated property and casualty insurers ("P&C Insurers") that, in addition to settling existing claims, establishes a going-forward process to collaboratively and timely resolve future claims, as well as share important historical data that is expected to enhance LifeWallet's claims reconciliation capabilities, benefiting its Medicare clients across the mainland U.S. and Puerto Rico. The settlement includes:

佛羅里達州科勒爾蓋布爾斯,2024年3月3日(GLOBE NEWSWIRE)——佛羅里達州科勒爾蓋布爾斯,2024年3月3日。MSP Recovery, Inc. d/b/a LifeWallet(納斯達克股票代碼:LIFW)(“LifeWallet” 或 “公司”)宣佈與28家附屬財產和意外傷害保險公司(“財產和意外傷害保險公司”)達成全面和解,該協議除了解決現有索賠外,還建立了持續的流程,以協作及時地解決未來的索賠,並分享重要的歷史數據,這些數據有望增強LifeWallet的索賠對賬能力,使其受益美國大陸和波多黎各的醫療保險客戶。和解協議包括:

  • The P&C Insurers' agreement to provide ten years of historical data (identifying all claims processed from January 1, 2014, through the present) and data sharing of future claims, extending out for one year, assisting LifeWallet in reconciling its current and future assigned Medicare claims;
  • The P&C Insurers' Implementation of LifeWallet's coordination of benefits clearinghouse solution;
  • A 5-year agreement to resolve cooperatively, or through binding mediation, relevant Medicare claims (liens) that LifeWallet owns today and in the future;
  • The P&C Insurers' agreement that they are primary payers for any unreimbursed Medicare lien that LifeWallet identifies from data sharing, and the P&C Insurers' agreement to assign all rights to collect against other third parties that either failed to pay liens or collected twice from Medicare funds and the P&C Insurers; and
  • A cash payment from the P&C Insurers to LifeWallet to settle existing historical claims (amount subject to confidentiality).
  • 財產和意外保險公司同意提供十年的歷史數據(確定從 2014 年 1 月 1 日到現在處理的所有索賠) 以及未來索賠的數據共享, 延長一年,協助LifeWallet覈對其當前和未來分配的醫療保險索賠;
  • 財產和意外保險公司的 實施LifeWallet的福利協調清算所解決方案;
  • 一份爲期5年的協議,旨在通過合作或通過具有約束力的調解解決LifeWallet現在和未來擁有的相關醫療保險索賠(留置權);
  • 財產和意外保險公司同意他們是LifeWallet通過數據共享確認的任何未報銷的醫療保險留置權的主要付款人,以及財產和意外保險公司同意轉讓所有向未能支付留置權或兩次從醫療保險基金和財產保險公司收取的第三方收取款項的權利;以及
  • 財產和意外保險公司向LifeWallet支付的現金款項,以解決現有的歷史索賠(金額受保密)。

Settlement Significance

和解的意義

This settlement agreement is the result of LifeWallet's more than ten-year commitment to revolutionize the fragmented healthcare reimbursement system with data-driven solutions, utilizing its extensive legal infrastructure to enforce Primary Payer1 obligations (from mostly property and casualty insurers), through years of federal and state litigation. The settlement creates an environment where Secondary Payers,2 such as health insurance plans and healthcare providers, discover Medicare liens owed to them and recover conditional payments from responsible primary plans, such as property and casualty insurers. As described by a federal appellate judge, when Secondary Payers "recover efficiently from Primary Payers, the Medicare Trust Fund does achieve cost savings."3

該和解協議是LifeWallet十多年來承諾通過數據驅動的解決方案徹底改變分散的醫療報銷系統的結果,利用其廣泛的法律基礎設施強制執行主要付款人的規定1 通過多年的聯邦和州訴訟承擔債務(主要來自財產和意外傷害保險公司)。該和解協議創造了一個環境,使二級付款人,2 例如健康保險計劃和醫療保健提供商,發現欠他們的醫療保險留置權,並從財產和意外傷害保險公司等負責任的主要計劃中收回有條件的付款。正如聯邦上訴法官所描述的那樣,當二級付款人 “有效地從主要付款人那裏恢復過來時,醫療保險信託基金確實可以節省成本”。3

LifeWallet is of the opinion the settlement demonstrates proof of concept that can potentially be replicated with other Primary Payers. However, LifeWallet notes that this settlement is not a guarantee that LifeWallet's portfolio of assigned claims (owed by other Primary Payers) can be settled with the same or similar terms. The settlement value is a combination of monetary and non-monetary considerations, with the non-monetary considerations involving LifeWallet obtaining data on all the claims that were processed and paid by the P&C Insurers, and the P&C Insurers' assignment of rights to collect against other responsible parties. This will enhance LifeWallet's ability to discover liens and recover payments owed, more quickly than through litigation. It also enables LifeWallet to pursue a diversified number of entities that failed to pay liens or collected twice for the same bills, both from the insurer and LifeWallet's assignor clients.

LifeWallet認爲,該和解協議證明了概念的證明,有可能與其他主要付款人一起復制。但是,LifeWallet指出,此次和解並不能保證LifeWallet的分配索賠組合(由其他主要付款人所欠)能夠以相同或相似的條款進行結算。結算價值是貨幣和非貨幣考慮因素的組合,非貨幣考慮因素涉及LifeWallet獲取財產和意外保險公司處理和支付的所有索賠的數據,以及財產和意外保險公司向其他責任方分配收款權。這將增強LifeWallet發現留置權和追回所欠款項的能力,速度比通過訴訟更快。它還使LifeWallet能夠追查各種未能支付留置權或兩次向保險公司和LifeWallet的轉讓人客戶收取相同賬單的實體。

LifeWallet Founder and CEO, John H. Ruiz, commented, "Today's news shows LifeWallet's significant progress in implementing our business model and commitment to achieving positive outcomes for healthcare entities across the country." LifeWallet Co-Founder and Chief Legal Officer, Frank C. Quesada, added, "We are hopeful these collaborative efforts will pave the way for similar resolutions with other property and casualty insurers, including those currently in negotiations with LifeWallet. This benefits all stakeholders willing to work together to address issues that have plagued the healthcare industry for decades and be part of the solution to improve the healthcare system for insurers, providers, and patients alike."

LifeWallet創始人兼首席執行官約翰·魯伊斯評論說:“今天的新聞顯示,LifeWallet在實施我們的商業模式方面取得了重大進展,並承諾爲全國各地的醫療機構取得積極成果。”LifeWallet聯合創始人兼首席法務官弗蘭克·克薩達補充說:“我們希望這些合作能夠爲與其他財產和意外傷害保險公司(包括目前正在與LifeWallet談判的保險公司)的類似決議鋪平道路。這有利於所有願意共同努力解決困擾醫療行業數十年的問題的利益相關者,併成爲改善保險公司、提供商和患者醫療保健系統的解決方案的一部分。”

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1 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.
2 "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).
3In re Avandia Mktg., Sales Pracs. & Prod. Liab. Litig., 685 F.3d 353, 365 (3d Cir. 2012).

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1 主要計劃” 或 “主要付款人” 在醫療保險二級付款人背景下使用,是指 “任何需要或負責爲主要計劃下的物品或服務(或其任何部分)付款的實體。這些實體包括但不限於保險公司或自保公司、第三方管理人員以及所有贊助或繳納團體健康計劃或大型團體健康計劃的僱主。” 42 C.F.R. § 411.21。
2 “次要付款人” 包括醫療保險C部分計劃以及下游實體。 MSP 追討索賠,有限責任公司訴ACE AmIns。有限公司。,974 f.3d 1305、1316(2020 年第 11 屆)。
3關於 Avandia Mktg.、Sales Pracs. & Prod.利亞布。Litig。,685 f.3d 353,365(3d Cir. 2012)。

Solving An Industry Problem

解決行業問題

The failure to follow the Medicare Secondary Payer Act ("MSP Act") is costing taxpayers billions of dollars. The law serves to protect original Medicare, Medicare Advantage plans, and downstream entities. Medicare loses money because it "pays in the dark" and relies on Primary Payers to report information to Centers for Medicare & Medicaid Services ("CMS").4 Primary Payers, however, often do not have the tools and resources in place to identify every reportable event. LifeWallet's data matching initiatives have created transparency, enabling LifeWallet's Secondary Payer clients to discover when a Medicare beneficiary is insured through other sources and recover reimbursements.

未能遵守《醫療保險二級付款人法》(“MSP法案”)使納稅人損失了數十億美元。該法律旨在保護最初的醫療保險、Medicare Advantage計劃和下游實體。醫療保險之所以虧損,是因爲它 “在黑暗中付款”,並依賴主要付款人向醫療保險和醫療補助服務中心(“CMS”)報告信息。4 但是,主要付款人通常沒有足夠的工具和資源來識別每個應報告的事件。LifeWallet的數據匹配計劃提高了透明度,使LifeWallet的二級付款人客戶能夠發現醫療保險受益人何時通過其他來源投保並收回報銷。

Historical reconciliation, assignment of P&C Insurers' rights, and 5-year agreement to resolve unreimbursed Medicare liens, without the need for litigation

歷史和解、財產和意外保險公司權利的分配,以及無需訴訟即可解決未報銷的醫療保險留置權的5年協議

This settlement is a crucial step in addressing the systemic problems arising from incomplete reporting because the settlement requires the P&C Insurers to share ten years of historical data on first and third-party claims. The P&C Insurers have agreed that for each unreimbursed Medicare lien that LifeWallet identifies from the historical data, they will assign to LifeWallet any rights they have to collect against those third parties that either failed to pay liens or collected twice from LifeWallet's clients (that paid with Medicare funds) and the P&C Insurer. This process further enhances LifeWallet's ability to discover liens owed by P&C Insurers and any other third parties that had payment responsibility, and to collect on its portfolio of current claim rights.

該和解協議是解決因報告不完整而產生的系統性問題的關鍵一步,因爲和解協議要求財產和意外保險公司共享十年的第一和第三方索賠歷史數據。財產和意外保險公司已同意,對於LifeWallet從歷史數據中確定的每筆未報銷的醫療保險留置權,他們將向未能支付留置權或兩次向LifeWallet客戶(使用醫療保險資金支付)和財產與意外保險公司收取的第三方收取的所有權利分配給LifeWallet。這一過程進一步增強了LifeWallet發現財產和意外保險公司和任何其他有付款責任的第三方所欠留置權的能力,並從其當前索賠權組合中收取款項的能力。

Furthermore, the settlement sets up a five-year agreement whereby the P&C Insurers agree to either resolve cooperatively, or through binding mediation, any future rights to unreimbursed liens, providing a structured process to work through lien repayment on a timely basis, without the need for costly and inefficient litigation. This applies to current and future LifeWallet clients.

此外,該和解協議制定了一項爲期五年的協議,根據該協議,財產和意外保險公司同意通過合作或通過具有約束力的調解來解決未來獲得未償還留置權的任何權利,從而提供了一個結構化的流程,可以及時完成留置權還款,無需進行昂貴且效率低下的訴訟。這適用於當前和未來的LifeWallet客戶。

Working towards real-time payer-based identification through LifeWallet's coordination of benefits clearinghouse

通過LifeWallet的福利信息交換所協調努力實現基於付款人的實時身份識別

Utilizing LifeWallet's unique payer-based knowledge, artificial intelligence ("AI") and blockchain-based LifeChain integrations, LifeWallet has developed a comprehensive coordination of benefits clearinghouse. This builds upon the Company's previously announced initiatives: "MSP Recovery and Palantir to Transform Connectivity Across the U.S. Healthcare System" and "LifeWallet Announces Significant Enhancements to LifeWallet Health with Advanced Tools for Providers and Patients."5 Through the seamless convergence of information technology and direct Application Programming Interface ("API") and/or similar data transfer protocols, LifeWallet's clients and Primary Payers can efficiently coordinate benefits. This integrated offering creates transparency and efficiency in claims reconciliation. Traditional methods that rely on Primary Payers to report to Medicare are flawed because Primary Payers often lack the necessary tools, resources, and data points to comply with the stringent data field requirements imposed by CMS. A direct data connection allows for more efficient communication of payments and coordination of recovery efforts when conditional payments are made.

利用LifeWallet獨特的基於付款人的知識、人工智能(“AI”)和基於區塊鏈的LifeChain集成,LifeWallet開發了全面的福利協調信息交換所。這建立在公司先前宣佈的舉措的基礎上:”MSP Recovery 和 Palantir 將改變整個美國醫療系統的連接和”LifeWallet宣佈爲提供者和患者提供高級工具,顯著改善LifeWallet的健康狀況5 通過信息技術和直接應用程序編程接口(“API”)和/或類似數據傳輸協議的無縫融合,LifeWallet的客戶和主要付款人可以有效地協調收益。這種綜合服務提高了索賠對賬的透明度和效率。依賴主要付款人向Medicare報告的傳統方法存在缺陷,因爲主要付款人通常缺乏必要的工具、資源和數據點來遵守CMS規定的嚴格數據字段要求。在進行有條件付款時,直接數據連接可以更有效地進行付款通信並協調追回工作。

This technology creates a substantial advancement in benefits management, coordination of insurance coverage, and claims resolution between parties. LifeWallet's ability to identify and coordinate benefits for medical claims will give its clients a significant payment reconciliation advantage over the rest of the industry. This also allows patients to gain access (with proper security protocols) to their claims data, which will provide clarity into what was billed, who originated the bill, and which payer(s) made payment(s). David Simmons, who has held several MSP policy roles at CMS and founded healthcare consulting firm, Ten One Strategies, commented on the LifeWallet coordination of benefits clearinghouse, saying, "Having all parties coordinate early in the process demonstrates that payer coordination can be an efficient and proactive partnership."

這項技術在福利管理、保險範圍的協調和各方之間的索賠解決方面取得了長足的進步。與業內其他公司相比,LifeWallet識別和協調醫療索賠福利的能力將爲其客戶帶來顯著的支付對賬優勢。這也使患者能夠(通過適當的安全協議)訪問他們的索賠數據,這將使人們清楚地了解賬單的開具者、賬單的發起人以及哪些付款人支付了款項。大衛·西蒙斯曾在CMS擔任過多個MSP政策職位,並創立了醫療保健諮詢公司Ten One Strategies。他在評論LifeWallet福利信息交換所的協調時說:“讓各方在流程的早期進行協調錶明,付款人協調可以成爲一種高效而積極的合作伙伴關係。”

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4 United States v. Baxter Int'l, Inc., 345 F.3d 866, 901 (11th Cir. 2003) ("When Medicare pays, therefore, it is paying 'in the dark'—it does not know, and cannot know, whether someone else will pay.).
5 October 11, 2021 Press Release re: MSP Recovery, now LifeWallet (NASDAQ: LIFW) and Palantir Technologies Inc., April 5, 2023 Press Release re: LifeWallet (NASDAQ: LIFW)

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4 美國訴百特國際公司,345 F.3D 866,901(2003年第11號法案)(“因此,當醫療保險付款時,它是在'在黑暗中'付款——它不知道,也不知道其他人是否會付款。)。
5 2021 年 10 月 11 日新聞稿關於:MSP Recovery,現爲 LifeWallet(納斯達克股票代碼:LIFW)和 Palantir Technologies Inc.,2023 年 4 月 5 日新聞稿回覆:LifeWallet(納斯達克股票代碼:LIFW)

LifeWallet's Business Model

LifeWallet 的商業模式

Since its founding in 2014 as MSP Recovery, LifeWallet has aimed to disrupt the antiquated healthcare reimbursement system with data-driven solutions, utilizing advanced technology and extensive legal expertise to recover reimbursements for Medicare, Medicaid, and commercial entities.

自2014年以MSP Recovery的名義成立以來,LifeWallet一直致力於通過數據驅動的解決方案顛覆過時的醫療報銷體系,利用先進的技術和廣泛的法律專業知識來追回醫療保險、醫療補助和商業實體的報銷。

LifeWallet Founder and CEO, John H. Ruiz, who worked with LifeWallet's counsel, Charlie Whorton, to achieve this settlement resolution, said, "This settlement encompasses the two most important concepts that LifeWallet set out to resolve — discover conditional payments and recover reimbursement from primary payers. While some insurers have failed to follow the law and been uncooperative, we commend those insurers that have stepped up to the plate to do what is required." Ruiz continued, "Our goal has been to create a more compliant and transparent environment, where secondary payers and primary plans are coordinating and sharing information. Such an environment ultimately serves to preserve the Medicare Trust Funds."

LifeWallet創始人兼首席執行官約翰·魯伊斯與LifeWallet的律師查理·沃頓合作達成了這項和解決議。他說:“該和解協議涵蓋了LifeWallet打算解決的兩個最重要的概念——發現有條件付款和向主要付款人追回報銷。儘管一些保險公司未能遵守法律並且不合作,但我們讚揚那些挺身而出做必要事情的保險公司。”魯伊斯繼續說:“我們的目標是創造一個更加合規和透明的環境,讓二級付款人和主要計劃能夠協調和共享信息。這樣的環境最終有助於保護醫療保險信託基金。”

Forward Looking Statements

前瞻性陳述

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.

本新聞稿包含聯邦證券法所指的前瞻性陳述。前瞻性陳述通常可以通過使用 “預期”、“相信”、“期望”、“打算”、“計劃” 和 “將” 等詞語來識別,或者在每種情況下使用其否定或其他變體或類似術語。這些前瞻性陳述包括所有非歷史事實的事項,包括例如有關未來潛在和解的陳述。就其性質而言,前瞻性陳述涉及風險和不確定性,因爲它們與事件有關,取決於未來可能發生或可能不會發生的情況。因此,這些陳述不能保證未來的業績或業績,實際事件可能與前瞻性陳述中表達或暗示的事件存在重大差異。本公司在此發表的任何前瞻性陳述僅代表截至發表之日。新的風險和不確定性不時出現,公司無法預測或確定所有這些事件或它們可能如何對其產生影響。除非聯邦證券法要求,否則公司沒有義務也不打算在本文發佈之日之後更新任何前瞻性陳述。可能導致這些差異的因素包括但不限於公司利用其轉讓協議和收回轉讓人支付的款項的能力;和解談判和/或訴訟中固有的不確定性,包括任何此類結果的金額和時機;公司定期和解調解的成功;向公司轉讓索賠的有效性;有關醫療保健數據分析和付款準確性的負面報道;以及其他因素包含在公司10-K表年度報告、10-Q表季度報告及其向美國證券交易委員會提交的其他報告中。這些聲明構成公司根據1995年《私人證券訴訟改革法》作出的警示性聲明。

About LifeWallet

關於 Life錢包

Founded 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 provides comprehensive solutions for multiple industries including healthcare, legal, education, and sports NIL, while innovating technologies to help save lives. For more information, visit: LIFEWALLET.COM

LifeWallet成立於2014年,名爲MSP Recovery,現已成爲醫療保險、醫療補助、商業和二級付款人報銷恢復的領導者,通過數據驅動的解決方案顛覆了過時的醫療報銷系統,以確保責任方追回款項。LifeWallet 爲包括醫療保健、法律、教育和體育在內的多個行業提供全面的解決方案,同時創新技術以幫助挽救生命。欲了解更多信息,請訪問:LIFEWALLET.COM

CONTACT: Contact  Media: ICR, Inc. lifewallet@icrinc.com  Investors: Investors@LifeWallet.com
聯繫人:聯繫媒體:ICR, Inc. lifewallet@icrinc.com 投資者:Investors@LifeWallet.com

譯文內容由第三人軟體翻譯。


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