Health Maintenance Organizations May Be Exempt from Anti-Subrogation Provisions.

The Pennsylvania Supreme Court decided the case of Wirth v. AETNA, U.S. Healthcare, 904 A.2d 858 (Pa. 2006), a decision finding that health maintenance organizations (HMOs), are exempt from the anti-subrogation provision of the Pennsylvania Motor Vehicle Financial Responsibility Law.  In Wirth, the Pennsylvania Supreme Court was asked to interpret two competing Pennsylvania statutory enactments: the Pennsylvania Health Maintenance Organization Act, (HMO Act), 40 P.S. §1551, et seq. and the anti-subrogation clause of the Pennsylvania Motor Vehicle Financial Responsibility Law, (MVFRL), 75 Pa.C.S. §1720. Under the HMO Act, HMOs are not subject to the laws of the Commonwealth of Pennsylvania relating to insurance corporations engaged in the business of insurance. 40 P.S. §1560(a). Therefore, AETNA argued that the anti-subrogation provisions found in the MVFRL did not apply to them. (Section 1720 of the MVFRL provides that, “In actions arising out of the maintenance or use of a motor vehicle, there shall be no right of subrogation from a claimant’s tort recovery with respect to...benefits paid or payable by a program, group contract or other arrangement...” Id.) 

As such, the Court found that the legislature did reference HMOs in other enactments, they ruled that the “program, group contract and other arrangement” language in Section 1720 was not intended to include HMOs. 

As such, legally it appears that the lien asserted by an HMO maybe valid and enforceable.