MSP Recovery, Inc. d/b/a LifeWallet (NASDAQ: LIFW) (“LifeWallet,”
or the “Company”), a Medicare, Medicaid, commercial, and secondary
payer reimbursement recovery and technology leader, today announced
financial results for the quarter ended September 30, 2024.
LifeWallet Chief Executive Officer, John H.
Ruiz, said, “From additional settlements to the processing of
additional claims data, we continue to see progress across all
lines of business. We’re also reaping the rewards of reduced
operating expenses, which have had a positive impact on our
financials. In addition to providing invaluable technological
resources to patients, providers, payers, and attorneys, our
cost-cutting solutions can discover wasted federal funds and
recover Medicare reimbursements to preserve tax dollars, benefiting
all Americans.”
Third Quarter Highlights
- On July 22, 2024,
the Company announced a new comprehensive settlement
with another group of affiliated property and
casualty insurance carriers (“P&C Insurers”) doing
business in multiple states, which includes the
P&C Insurers' agreement to provide ten years of historical data
and data sharing of future claims, implementation of LifeWallet's
clearinghouse solution to settle future claims, and assignment of
additional rights to collect against additional third parties
related to the settled claims.
- The Company entered
into a confidential pharmaceutical antitrust settlement totaling
$3.1 million. As part of LifeWallet’s owned claims portfolio, the
Company has claims against multiple pharmaceutical and medical
device manufacturers based on allegations of defective products or
anti-competitive pricing.
- The Company
launched an initiative to secure new agreements with health plans,
providers, insurers and attorneys, while continuing to reduce
operating costs.
- Creditors Virage
Capital Management LP; Virage Recovery Master, LP; Hazel Holdings
I, LLC; and Hazel Partners Holdings, LLC agreed to waive certain
provisions in their agreements with the Company that would
accelerate the payment of amounts due in the event that the Company
receives a negative going concern opinion from its auditors for the
year ending December 31, 2024.
Subsequent Events
- On November 11,
2024, the Company announced new comprehensive settlements with
P&C Insurers, totaling $5.2 million, continued progress in
recoveries on owned claims and acquiring rights to additional
claims, as well as initiatives to eliminate wasteful Medicare
spending by launching beta testing of its clearinghouse solution,
built in partnership with Palantir Technologies, Inc. (NYSE:
PLTR).
- LifeWallet is also
currently in negotiations with other property and casualty insurers
to resolve claims on a similar basis, including one of the
country’s largest P&C Insurers. Some of these negotiations have
resulted in collaborative statistical sampling and extensive
data-matching to determine the size and scope of claims that are
owned by the Company that LifeWallet has asserted repayment is due
pursuant to Medicare Secondary Payer and other related laws.
- The Company entered
into a confidential settlement with a medical device manufacturer
totaling $760,000. As part of LifeWallet’s owned claims portfolio,
the Company has ongoing litigation against other pharmaceutical and
medical device manufacturers based on claims of defective products
or anti-competitive pricing.
- The Company
acquired the recovery rights to additional Medicare Secondary Payer
claims consisting of more than 450,000 Medicare members, as
documented by health insurance plans, with an estimated total
claims Paid Amount exceeding $10.6 billion.1
- LifeWallet
strategically reduced its operating costs in 2023 and continues to
do so in 2024. These cost reductions do not impact the systems that
the Company has already created to support recovery efforts of the
claims owned by the Company or other resources available to third
parties. The Company anticipates these reductions could continue to
contribute savings to operating expenses for the year ending
December 31, 2024.
- The Company is
advancing initiatives to eliminate wasteful spending of federal
dollars and unnecessary Medicare secondary payments, utilizing its
clearinghouse system, created through its exclusive healthcare
partnership with Palantir Technologies. The clearinghouse solution
utilizes the Palantir Foundry platform, AI tools, natural language
processing, and machine learning, resulting in the development of a
sophisticated data analytics system that captures and manages
healthcare data, enhancing LifeWallet’s Chase to Pay model.
Third Quarter Financial
Highlights
-
Revenue: Total revenue for the three months ended
September 30, 2024 was $3.7 million compared to $0.4 million for
three months ended September 30, 2023.
- Operating
loss: Operating loss for the three months ended September
30, 2024 was $129.9 million, compared to $136.7 million during
three months ended September 30, 2023. Adjusted operating loss for
the three months ended September 30, 2024 was $8.4 million,
excluding non-cash claims amortization expense of $121.0 million
and professional fees paid in stock of $0.4 million.
- Net
loss: Net loss for the three months ended September 30,
2024 was $190.4 million and $160.5 million to controlling members,
or net loss per share of $1.26 per share, Class A Common Stock,
based on 23,764,079 million weighted average shares of Class A
Common Stock outstanding. Adjusted net loss for the three months
ended September 30, 2024 was $11.0 million, excluding the non-cash
item noted above, change in fair value of warrant and derivative
liabilities of $45.3 million, and $103.3 million related to
interest expense.
-
Liquidity: As of September 30, 2024, cash totaled
$4.7 million, and as of October 31, 2024, cash totaled $5.6
million. The Company continually monitors its liquidity and may in
the future access debt and equity markets as necessary in order to
meet its ongoing liquidity needs, including by drawing upon its
working capital facility. For the three months ended September 30,
2024, the Company received $5.25 million of funding for working
capital. Subsequently, the Company has received additional working
capital funding of $3.5 million, and it has $5.25 million of
remaining capacity to draw from its working capital facility as of
the date of filing of the Quarterly Report on Form 10-Q for the
period ending September 30, 2024.
Assigned Recovery Rights, Claims Paid
and Billed Value
The table below outlines the Company’s claims
data for the most recent periods. The amounts represent data
received from current and new assignors:
$ in
billions |
Nine Months Ended September 30,
2024 |
|
|
Year Ended December 31, 2023 |
|
|
Year EndedDecember 31, 2022 |
|
Paid Amount |
$ |
380.5 |
|
|
$ |
369.8 |
|
|
$ |
374.8 |
|
Paid Value of Potentially
Recoverable Claims(2) |
|
87.8 |
|
|
|
88.9 |
|
|
|
89.6 |
|
Billed Value of Potentially
Recoverable Claims |
|
375.3 |
|
|
|
373.5 |
|
|
|
377.8 |
|
Recovery Multiple |
N/A(1) |
|
|
N/A |
|
|
N/A |
|
Penetration Status of
Portfolio |
|
86.8 |
% |
|
|
86.8 |
% |
|
|
85.8 |
% |
1) During the nine months ended
September 30, 2024, the Company has received total recoveries
of $9.9 million. However, the settlement amounts do not provide a
large enough sample to be statistically significant, and are
therefore not shown in the table.
2) On August 10, 2022, the United States Court
of Appeals, Eleventh Circuit held that a four-year statute of
limitations period applies to certain claims brought under the
Medicare Secondary Payer Act’s private cause of action, and that
the limitations period begins to run on the date that the cause of
action accrued. This opinion may render certain Claims held by the
Company unrecoverable and may substantially reduce PVPRC and BVPRC
as calculated. As our cases were filed at different times and in
various jurisdictions, and prior to data matching with a defendant
we are not able to accurately calculate the entirety of damages
specific to a given defendant, we cannot calculate with certainty
the impact of this ruling at this time. However, the Company has
deployed several legal strategies (including but not limited to
seeking to amend existing lawsuits in a manner that could allow
claims to relate back to the filing date as well as asserting
tolling arguments based on theories of fraudulent concealment) that
would apply to tolling the applicable limitations period and
minimizing any material effect on the overall collectability of its
claim rights. In addition, the Eleventh Circuit decision applies
only to district courts in the Eleventh Circuit. Many courts in
other jurisdictions have applied other statutes of limitations to
the private cause of action, including borrowing the three-year
statute of limitations applicable to the government’s cause of
action; and borrowing from the False Claims Act’s six-year period.
The most recent decision on the issue from the District Court of
Massachusetts, for example, applies the same statute of limitations
as Eleventh Circuit, but expressly disagrees with the Eleventh
Circuit’s application of the “accrual” rule and instead adopted the
notice-based trigger that the company has always argued should
apply. This would mean that the limitations period for unreported
claims has not even begun to accrue. This is a complex legal issue
that will continue to evolve in jurisdictions across the country.
Nevertheless, if the application of the statute of limitations as
determined by the Eleventh Circuit was applied to all Claims
assigned to us, we estimate that the effect would be a reduction of
PVPRC by approximately $9.9 billion. As set forth in our Risk
Factors, PVPRC is based on a variety of factors. As such, this
estimate is subject to change based on the variety of legal claims
being litigated and statute of limitations tolling theories that
apply.
Going Concern
As disclosed in the Company’s Quarterly Report
on Form 10-Q, the Company has concluded that, despite the financing
arrangements entered into by the Company, there is substantial
doubt about its ability to continue as a going concern. Unless the
Company is successful in raising additional funds through the
offering of debt or equity securities, the Company has concluded it
is probable the Company will be unable to continue to operate
as a going concern beyond the next
12 months.
Non-GAAP Financial Measures
Additional information regarding the non-GAAP
financial measures discussed in this release, including an
explanation of these measures and how each is calculated, is
included below under the heading “Non-GAAP Financial Measures.” A
reconciliation of GAAP to non-GAAP financial measures has also been
provided in the financial tables.
About LifeWallet
Founded in 2014 as MSP Recovery, LifeWallet has become a
Medicare, Medicaid, commercial, and secondary payer reimbursement
recovery leader, disrupting the antiquated healthcare reimbursement
system with data-driven solutions to secure recoveries from
responsible parties. LifeWallet innovates technologies and provides
comprehensive solutions for multiple industries including
healthcare, legal, and sports NIL. For more information, visit:
LIFEWALLET.COM
Forward Looking Statements
This release contains forward-looking statements
within the meaning of the federal securities laws. Forward-looking
statements may generally be identified by the use of words such as
“anticipate,” “believe,” “expect,” “intend,” “plan” and “will” or,
in each case, their negative, or other variations or comparable
terminology. By their nature, forward-looking statements involve
risks and uncertainties because they relate to events and depend on
circumstances that may or may not occur in the future. As a result,
these statements are not guarantees of future performance or
results and actual events may differ materially from those
expressed in or suggested by the forward-looking statements. Any
forward-looking statement made by MSP Recovery herein speaks only
as of the date made. New risks and uncertainties come up from time
to time, and it is impossible for LIFW to predict or identify all
such events or how they may affect it. LIFW has no obligation, and
does not intend, to update any forward-looking statements after the
date hereof, except as required by federal securities laws. Factors
that could cause these differences include, but are not limited to,
LIFW’s ability to capitalize on its assignment agreements and
recover monies that were paid by the assignors; the inherent
uncertainty surrounding settlement negotiations and/or litigation,
including with respect to both the amount and timing of any such
results; the validity of the assignments of claims to LIFW; the
ability to successfully expand the scope of LIFW’s claims or obtain
new data and claims from LIFW’s existing assignor base or
otherwise; LIFW’s ability to innovate and develop new solutions,
and whether those solutions will be adopted by LIFW’s existing and
potential assignors; negative publicity concerning healthcare data
analytics and payment accuracy; and those additional factors
included in LIFW’s Annual Report on Form 10-K, Quarterly Reports on
Form 10-Q and other reports filed by it with the Securities and
Exchange Commission. These statements constitute the Company’s
cautionary statements under the Private Securities Litigation
Reform Act of 1995.
Contact
Media:
Media@LifeWallet.com
Investors:
Investors@LifeWallet.com
MSP RECOVERY, INC. and
SubsidiariesCondensed Consolidated Balance
Sheets(Unaudited) |
|
|
|
|
|
|
|
|
|
September 30, |
|
|
December 31, |
|
(In thousands, except share
and per share data) |
|
2024 |
|
|
2023 |
|
ASSETS |
|
|
|
|
|
|
Current
assets: |
|
|
|
|
|
|
Cash |
|
$ |
4,746 |
|
|
$ |
11,633 |
|
Accounts receivable |
|
|
3,100 |
|
|
|
217 |
|
Affiliate receivable (1) |
|
|
1,222 |
|
|
|
1,188 |
|
Prepaid expenses and other current assets (1) |
|
|
1,692 |
|
|
|
8,908 |
|
Total current assets |
|
|
10,760 |
|
|
|
21,946 |
|
Property and equipment, net |
|
|
4,866 |
|
|
|
4,911 |
|
Intangible assets, net (2) |
|
|
2,771,969 |
|
|
|
3,132,796 |
|
Right-of-use assets |
|
|
257 |
|
|
|
342 |
|
Total assets |
|
$ |
2,787,852 |
|
|
$ |
3,159,995 |
|
|
|
|
|
|
|
|
LIABILITIES AND
EQUITY |
|
|
|
|
|
|
Current
liabilities: |
|
|
|
|
|
|
Accounts payable |
|
$ |
10,767 |
|
|
$ |
6,244 |
|
Affiliate payable (1) |
|
|
20,637 |
|
|
|
19,822 |
|
Commission payable |
|
|
1,222 |
|
|
|
821 |
|
Derivative liability |
|
|
110 |
|
|
|
37 |
|
Warrant liability (1) |
|
|
27,012 |
|
|
|
268 |
|
Guaranty obligation (1) |
|
|
1,077,070 |
|
|
|
— |
|
Claims financing obligation and notes payable (1) |
|
|
43,267 |
|
|
|
— |
|
Interest payable (1) |
|
|
11,096 |
|
|
|
— |
|
Other current liabilities (1) |
|
|
14,813 |
|
|
|
19,314 |
|
Total current liabilities |
|
|
1,205,994 |
|
|
|
46,506 |
|
Guaranty obligation (1) |
|
|
— |
|
|
|
941,301 |
|
Claims financing obligation and notes payable (1) |
|
|
588,513 |
|
|
|
548,276 |
|
Lease liabilities |
|
|
138 |
|
|
|
235 |
|
Loan from related parties (1) |
|
|
130,328 |
|
|
|
130,709 |
|
Interest payable (1) |
|
|
12,655 |
|
|
|
73,839 |
|
Other long-term liabilities |
|
|
3,236 |
|
|
|
— |
|
Total liabilities |
|
$ |
1,940,864 |
|
|
$ |
1,740,866 |
|
|
|
|
|
|
|
|
Commitments and contingencies (Note 13) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Stockholders’
Equity: |
|
|
|
|
|
|
Class A common stock, $0.0001 par value; 5,500,000,000 shares
authorized; 30,975,324 and 14,659,794 issued and outstanding as of
September 30, 2024 and December 31, 2023, respectively |
|
$ |
3 |
|
|
$ |
1 |
|
Class V common stock, $0.0001 par value; 3,250,000,000 shares
authorized; 124,067,498 and 124,132,398 issued and outstanding as
of September 30, 2024 and December 31, 2023, respectively |
|
|
12 |
|
|
|
12 |
|
Additional paid-in capital |
|
|
459,748 |
|
|
|
357,928 |
|
Accumulated deficit |
|
|
(159,416 |
) |
|
|
(85,551 |
) |
Total stockholders’ equity |
|
$ |
300,347 |
|
|
$ |
272,390 |
|
Non-controlling interest |
|
|
546,641 |
|
|
|
1,146,739 |
|
Total equity |
|
$ |
846,988 |
|
|
$ |
1,419,129 |
|
Total liabilities and equity |
|
$ |
2,787,852 |
|
|
$ |
3,159,995 |
|
1) As of September 30, 2024 and
December 31, 2023, the total affiliate receivable, affiliate
payable, warrant liability, guaranty obligation and loan from
related parties balances are with related parties. In addition, the
prepaid expenses and other current assets, claims financing
obligation and notes payable, other current liabilities, and
interest payable include balances with related parties. See Note
15, Related Party Transactions, for further details.2) As of
September 30, 2024 and December 31, 2023, intangible
assets, net included $2.0 billion and $2.2 billion, respectively,
related to a consolidated VIE. See Note 9, Variable Interest
Entities, for further details.
The accompanying notes are an integral part of
these unaudited condensed consolidated financial statements.
MSP RECOVERY, INC. and
SubsidiariesCondensed Consolidated Statements of
Operations(Unaudited) |
|
|
|
|
|
|
|
|
|
Three Months Ended September 30, |
|
|
Nine Months Ended September 30, |
|
(In thousands, except share
and per share data) |
|
2024 |
|
|
2023 |
|
|
2024 |
|
|
2023 |
|
Claims recovery income |
|
$ |
3,577 |
|
|
$ |
440 |
|
|
$ |
9,879 |
|
|
$ |
6,479 |
|
Claims recovery service
income |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
498 |
|
Other |
|
|
91 |
|
|
|
— |
|
|
|
127 |
|
|
|
— |
|
Total
Revenues |
|
$ |
3,668 |
|
|
$ |
440 |
|
|
$ |
10,006 |
|
|
$ |
6,977 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating expenses |
|
|
|
|
|
|
|
|
|
|
|
|
Cost of revenues (1) |
|
|
1,671 |
|
|
|
574 |
|
|
|
3,453 |
|
|
|
1,972 |
|
Claims amortization expense |
|
|
121,007 |
|
|
|
121,008 |
|
|
|
363,027 |
|
|
|
355,481 |
|
General and administrative (2) |
|
|
5,329 |
|
|
|
6,130 |
|
|
|
17,145 |
|
|
|
20,691 |
|
Professional fees |
|
|
3,248 |
|
|
|
2,466 |
|
|
|
12,030 |
|
|
|
15,611 |
|
Professional fees – legal (3) |
|
|
2,213 |
|
|
|
6,871 |
|
|
|
9,146 |
|
|
|
25,889 |
|
Allowance for credit losses |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,000 |
|
Depreciation and amortization |
|
|
71 |
|
|
|
85 |
|
|
|
206 |
|
|
|
182 |
|
Total operating expenses |
|
|
133,539 |
|
|
|
137,134 |
|
|
|
405,007 |
|
|
|
424,826 |
|
Operating Loss |
|
$ |
(129,871 |
) |
|
$ |
(136,694 |
) |
|
$ |
(395,001 |
) |
|
$ |
(417,849 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Interest expense (4) |
|
|
(106,653 |
) |
|
|
(88,279 |
) |
|
|
(306,596 |
) |
|
|
(204,287 |
) |
Other income (expense),
net |
|
|
799 |
|
|
|
408 |
|
|
|
1,140 |
|
|
|
8,697 |
|
Change in fair value of
warrant and derivative liabilities |
|
|
45,341 |
|
|
|
348 |
|
|
|
121,625 |
|
|
|
4,247 |
|
Net loss before
provision for income taxes |
|
$ |
(190,384 |
) |
|
$ |
(224,217 |
) |
|
$ |
(578,832 |
) |
|
$ |
(609,192 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Provision for income tax expense |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Net loss |
|
$ |
(190,384 |
) |
|
$ |
(224,217 |
) |
|
$ |
(578,832 |
) |
|
$ |
(609,192 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Less: Net loss attributable to non-controlling interests |
|
|
160,537 |
|
|
|
204,462 |
|
|
|
504,967 |
|
|
|
576,301 |
|
Net loss attributable
to MSP Recovery, Inc. |
|
$ |
(29,847 |
) |
|
$ |
(19,755 |
) |
|
$ |
(73,865 |
) |
|
$ |
(32,891 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic and diluted weighted
average shares outstanding, Class A Common Stock |
|
|
23,764,079 |
|
|
|
12,703,472 |
|
|
|
18,586,357 |
|
|
|
7,097,032 |
|
Basic and diluted net
loss per share, Class A Common Stock |
|
$ |
(1.26 |
) |
|
$ |
(1.56 |
) |
|
$ |
(3.97 |
) |
|
$ |
(4.63 |
) |
1) For both the three and nine months ended
September 30, 2024, cost of revenue included $1.3 million of
related party expenses. For both the three and nine months ended
September 30, 2023, cost of revenue included $0.3 million of
related party expenses. See Note 15, Related Party Transactions,
for further details.2) For the three and nine months ended
September 30, 2024, general and administrative expenses
included $89.1 thousand and $180.8 thousand of related party
expenses, respectively. See Note 15, Related Party Transactions,
for further details. No such related party expenses were present
for the three and nine months ended September 30, 2023.3) For
the three and nine months ended September 30, 2024 and 2023,
Professional Fees—legal included $1.7 million and $7.7 million, and
$4.6 million and $13.5 million, respectively, of related party
expenses related to the Law Firm. See Note 15, Related Party
Transactions, for further details.4) For the three and nine months
ended September 30, 2024 and 2023, interest expense included
$80.8 million and $233.3 million, and $69.1 million and $163.1
million, respectively, related to interest expense due to related
parties. See Note 15, Related Party Transactions, for further
details.
The accompanying notes are an integral part of
these unaudited condensed consolidated financial statements.
Non-GAAP Financial Measures
MSP RECOVERY, INC. and
SubsidiariesNon-GAAP Reconciliation |
|
|
|
|
|
|
|
|
|
Three Months Ended September 30, |
|
|
Nine Months Ended September 30, |
|
(In thousands) |
|
2024 |
|
|
2023 |
|
|
2024 |
|
|
2023 |
|
GAAP Operating Loss |
|
$ |
(129,871 |
) |
|
$ |
(136,694 |
) |
|
$ |
(395,001 |
) |
|
$ |
(417,849 |
) |
Professional fees paid in stock |
|
|
416 |
|
|
|
1,875 |
|
|
|
1,484 |
|
|
|
1,875 |
|
Claims amortization expense |
|
|
121,007 |
|
|
|
121,008 |
|
|
|
363,027 |
|
|
|
355,481 |
|
Allowance for credit losses |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,000 |
|
Adjusted Operating Loss |
|
$ |
(8,448 |
) |
|
$ |
(13,811 |
) |
|
$ |
(30,490 |
) |
|
$ |
(55,493 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
GAAP Net
Loss |
|
$ |
(190,384 |
) |
|
$ |
(224,217 |
) |
|
$ |
(578,832 |
) |
|
$ |
(609,192 |
) |
Professional fees paid in stock |
|
|
416 |
|
|
|
1,875 |
|
|
|
1,484 |
|
|
|
1,875 |
|
Claims amortization expense |
|
|
121,007 |
|
|
|
121,008 |
|
|
|
363,027 |
|
|
|
355,481 |
|
Allowance for credit losses |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
5,000 |
|
Interest expense (1) |
|
|
103,336 |
|
|
|
88,279 |
|
|
|
302,101 |
|
|
|
204,287 |
|
Change in fair value of warrant and derivative liabilities |
|
|
(45,341 |
) |
|
|
(348 |
) |
|
|
(121,625 |
) |
|
|
(4,247 |
) |
Adjusted Net Loss |
|
$ |
(10,966 |
) |
|
$ |
(13,403 |
) |
|
$ |
(33,845 |
) |
|
$ |
(46,796 |
) |
In addition to the financial measures prepared
in accordance with GAAP, this Quarterly Report also contains
non-GAAP financial measures. We consider “adjusted net loss” and
“adjusted operating loss” as non-GAAP financial measures and
important indicators of performance and useful metrics for
management and investors to evaluate the Company’s ongoing
operating performance on a consistent basis across reporting
periods. We believe these measures provide useful information to
investors. Adjusted net loss represents net loss adjusted for
certain non-cash and non-recurring expenses, and adjusted operating
loss items represents operating loss adjusted for certain non-cash
and non-recurring expenses. A reconciliation of these non-GAAP
measures to their most relevant GAAP measure is included above.
(1) Interest expense included above excludes any
interest expense payments made in cash during the three and nine
months ended September 30, 2024.
_______________________________1 ”Paid
Amount” (a/k/a Medicare Paid Rate or wholesale price) means the
amount paid to the provider from the health plan or insurer. This
amount varies based on the party making payment. For example,
Medicare typically pays a lower fee for service rate than
commercial insurers. The Paid Amount is derived from the Claims
data we receive from our Assignors. In the limited instances where
the data received lacks a paid value, our team calculates the Paid
Amount with a formula. The formula used provides rates for
outpatient services and is derived from the customary rate at the
95th percentile as it appears from standard industry commercial
rates or, where that data is unavailable, the Billed Amount if
present in the data. These amounts are then adjusted to account for
the customary Medicare adjustment to arrive at the calculated Paid
Amount. Management believes that this formula provides a
conservative estimate for the Medicare paid amount rate, based on
industry studies which show the range of differences between
private insurers and Medicare rates for outpatient services. We
periodically update this formula to enhance the calculated paid
amount where that information is not provided in the data received
from our Assignors. Management believes this measure provides a
useful baseline for potential recoveries, but it is not a measure
of the total amount that may be recovered in respect of potentially
recoverable Claims, which in turn may be influenced by any
applicable potential statutory recoveries such as double damages or
fines. Where we have to extrapolate a Paid Amount to establish
damages, the calculated amount may be contested by opposing
parties. The figures pertaining to Medicare Member Lives as well as
the paid amount were tabulated based on the data provided by health
care plans; these figures may be subject to adjustment upon further
investigation of the paid amounts reflected by the health
plans.
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