Liberty Nat’l Life Ins. Co. v. Radiotherapy of Ga.

Liberty Nat’l Life Ins. Co. v. Radiotherapy of Ga.,
P.C., No. A01A1380 (Ga. Ct. App. Nov. 21, 2001)

The Georgia Court of Appeals held that an insurance company’s failure to exercise
due diligence precluded its recovery, and granted summary judgment to two healthcare
providers who allegedly submitted billing statements to the insurance company
that included amounts the providers were foreclosed by federal law from recovering.

The evidence showed that the insurance company knew as early as 1993 that there
were often discrepancies between the actual charges of health care providers
and the allowable charges under Medicare. And because the insurance company
could have ascertained the actual information for any medical procedure had
it troubled itself to do so, it could not show that it exercised due diligence.
Therefore, defendants were entitled to judgment as a matter of law. The insurance
company similarly failed to show that the defendants incorporated false, inaccurate,
or misleading information into their billing statements in an attempt to induce
it to rely and act to its detriment on that information. The voluntary payment
doctrine precluded the insurance company’s recovery.