Ametros Financial Corporation offers “post-settlement medical administration services.” This means that when a person receives a settlement, for example, from a liability lawsuit or workers’ compensation, Ametros offers to manage those funds. However, the complaint for this class action alleges that the company does not deliver on what it offers.
Plaintiff Joshua Sharp was injured, presumably on the job. In July 2015, a court approved the settlement of for his workers’ compensation suit against his employer.
At the same time, Sharp entered into a Medical Cost Projection Post-Settlement Administration Agreement with Ametros. Sharp did not choose Ametros. The complaint alleges that Millennium Risk Managers, the third-party administrator for the settlement chose the company.
According to the agreement, Ametros would administer the settlement funds for Sharp’s forecasted medical expenses via its CareGuide payment service.
Sharp’s settlement includes annual payments of over $24,000 and Non-Medicare Expense Fund with annual payments of over $74,000, both for a maximum of thirty-four years. Sharp pays Ametros two $450 fees per year for its administration of these funds.
The complaint cites some of the promises the company makes: “Ametros promises that its members can save on healthcare and that it will obtain major discounts on medical services. Specifically, Ametros claims on its website that [it] saves its members ‘on average 62% on provider visits and 28% on your prescriptions.’”
Also, under its agreement with Sharp, the company has a duty to “use commercially reasonable efforts to secure retail discounted purchases to Member for prescription drugs, durable medical equipment and other health related services…” Ametros can do this, it claims, because its thousands of clients allow it to “negotiate network purchasing discounts” on their behalf.
However, the complaint claims that Sharp has not received these benefits: “For a selection of Mr. Sharp’s medical claims for the years 2017 and 2018, Ametros received no discount on pharmacy claims, and Ametros actually paid out more than the billed charges for those claims.” Also, “[f]or the same claims period, the average discount negotiated by Ametros for Mr. Sharp’s professional claims was only 9%. The average discount negotiated on specialty claims (DME, imaging, etc.) was less than 1%.”
Also, Ametros “completely exhausted each of Mr. Sharp’s two settlement funds in each of the last 3 years for which [it] administered the funds. In at least one year, Mr. Sharp’s funds were exhausted many months before” the annual payout date. The complaint claims that the depletion was caused by Ametros’s failure to get him pharmacy and DME discounts.
The complaint cites counts such as breach of contract, intentional misrepresentation, and conversion.
The class for this action is all persons who, at any time between August 30, 2013 to the present, had a Medical Cost Projection Post-Settlement Administration Agreement with Ametros and received services thereunder through CareGuard.