Virginia Pharmacy is “Health Care Provider” for Purposes of Statute of Limitations
A Virginia pharmacy is a “health care provider” that must file its claims within the one-year period prescribed in Va. Code Ann. § 65.2-605.1(F), held the Court of Appeals of Virginia [Summit Pharmacy, Inc. v. Costco Wholesale, 2021 Va. App. LEXIS 49 (Mar. 30, 2021)]. Accordingly, where it sought reimbursement for prescriptions prepared and filled for an injured worker, receiving its last partial payment in January 2015, it could not seek additional payments by filing a claim with the Commission in July 2019.
Background
A Costco employee sustained a work-related injury in March 2011. In December 2011, the Commission granted the employee lifetime medical benefits for her injury, and Summit Pharmacy provided prescriptions to the employee in 2014 to address her injury. Costco made only partial payments to Summit Pharmacy for its bill for those prescriptions, and Summit Pharmacy received its last partial payment in January 2015. Summit Pharmacy filed claims with the Commission in July 2019 seeking full payment for the prescriptions. The Commission denied Summit Pharmacy’s claims because it determined that Summit Pharmacy failed to file the claims within the one-year statute of limitations prescribed by Code § 65.2-605.1(F).
Health Care Provider
On appeal, Summit Pharmacy argued, in relevant part, that the Commission erred because the statute of limitations under Code § 65.2-605.1(F) did not apply to its claims. It contended that Code § 65.2-605.1(F) applied only to claims made by a “health care provider” and that the term “health care provider” did not include pharmacies.
Appellate Court Decision
The Court noted that the term “health care provider” was not defined within the statute. The Court noted, however, that Va. Code Ann. § 65.2-714(D)—a statute that prohibited a health care provider from “balance billing” an employee under the Workers’ Compensation Act—provided that the term “health care provider” was defined by Code § 8.01-581.1. The Court stressed that a plain reading of Code § 65.2-714(D) and Code § 65.2-605.1(F) demonstrated that the General Assembly intended for the definition of “health care provider” found in Code § 8.01-581.1 also to apply to Code § 65.2-605.1(F).
The Court continued, noting Code § 8.01-581.1 defined a “health care provider” as “a person, corporation, facility or institution licensed by this Commonwealth to provide health care or professional services as a … pharmacist.” The Court said that the General Assembly, therefore, had mandated that pharmacies were to be considered health care providers under Code § 65.2-714(D).
In as much as there was no dispute that Summit Pharmacy was a pharmacy licensed by the Commonwealth and since the General Assembly had not carved out an exception for pharmacists under Code § 65.2-605.1(F), the Court held that Summit Pharmacy was a “health care provider,” and accordingly, it was required to comply with the statute of limitations contained in Code § 65.2-605.1(F). Since there was no dispute that Summit Pharmacy had failed to file its claim within prescribed one-year period, its claim was barred.