This significant decision is Wolfe v Secretary of Veterans Affairs (CAFC No. 2020-1958, 3/17/2022). It pertains to the Department of Veterans Affairs (VA) reimbursement for hospital visits for veterans enrolled in the VA health care system. The law bars VA from reimbursing “any copayment or similar payment.” (Opinion p. 2) VA regulation implementing this language from the law prohibits reimbursing deductibles and coinsurance as the agency deems such payments constitute “similar payments.” (Opinion pp. 2-3)
A group of plaintiffs challenged this restriction before the Veterans Court and won a ruling from that court that upended VA’s regulation. The Veterans Court issued a writ of mandamus that required that VA allow reimbursement of deductibles and coinsurance, required VA to readjudicate all such claims, and certified a class of plaintiffs.
VA appealed this Veterans Court decision to the Federal Circuit Court of Appeals.
Simply stated, the issue in the case is whether deductibles and coinsurance payments are properly barred by VA under the law’s language “similar payments.” And also simply stated, the appeals court has held that “Because deductibles are excluded from reimbursement under the correct interpretation of the statue and other adequate remedies were available…We reverse.” (Opinion p. 3)
