Opinion ID: 2972492
Heading Depth: 2
Heading Rank: 3

Heading: Balance-Billing Prohibition

Text: Having determined that neither of the two state-court judgments preclude this action, we turn to the merits of the Trust’s claim. In its motion for summary judgment, the Trust argues that Spectrum’s lien on the settlement proceeds violates Medicaid’s balance-billing prohibition, and therefore is invalid. Because we conclude that by accepting Medicaid payments Spectrum waived its right to its customary fee for services provided to Bowling, we reverse the district court’s ruling on this ground. In 1965, Congress established Medicaid through Title XIX of the Social Security Act, 42 U.S.C. §§ 1396-1396v, to provide medical care to low-income families and individuals. Barney v. Holzer Clinic, Ltd., 110 F.3d 1207, 1210 (6th Cir. 1997). The Medicaid program is “based on a Nos. 04-1486/1541 Spectrum Health Continuing Care Group Page 8 v. Anna Marie Bowling Irrevocable Trust scheme of cooperative federalism,” King v. Smith, 392 U.S. 309, 316 (1968), in which a state elects to adopt a plan providing medical care to its low-income citizens in return for the federal government subsidizing the bulk of the plan’s financial obligations. Barney, 110 F.3d at 1210. A state is not required to participate in the program, but once it chooses to do so, the state’s plan must comply with federal statutory and regulatory standards. Pa. Med. Soc’y v. Snider, 29 F.3d 886, 888 (3d Cir. 1994); 42 U.S.C. §§ 1396a(b); 1396c. The State of Michigan elected to participate in the Medicaid program and therefore must comply with all aspects of federal law. See Mich. Comp. Laws Ann. § 400.105(1). One of the federal statutory requirements is that a state plan must establish payment rates for the various services provided under the plan. 42 U.S.C. § 1396a(a)(30). The payment rates must be “consistent with efficiency, economy, and quality of care and . . . sufficient to enlist enough providers so that care and services are available under the plan.” Id. A health-care provider is not required to participate in the Medicaid program, but rather voluntarily contracts with the state to provide services to Medicaid-eligible patients in return for reimbursement from the state at the specified rates. Barney, 110 F.3d at 1211; Linton by Arnold v. Comm’r of Health & Env’t, 65 F.3d 508, 515 (6th Cir. 1995), cert. denied, 517 U.S. 1155 (1996). Though the Medicaid rates are typically lower than a service provider’s customary fees, “medical service providers must accept the state-approved Medicaid payment as payment-in-full, and may not require that patients pay anything beyond that amount.” Barney, 110 F.3d at 1210. Moreover, even when a third party is subsequently found liable for the Medicaid beneficiary’s medical expenses, the service provider “may not seek to collect from the individual (or any financially responsible relative or representative of that individual) payment of an amount for that service.” 42 U.S.C. § 1396a(a)(25)(C). The accompanying federal regulations mandate that a state “must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan to be paid by the individual.” 42 C.F.R. § 447.15. Consistent with this federal regulation, service providers in the Michigan Medicaid program must “accept payment from the state as payment in full by the medically indigent individual for services received.” Mich. Comp. Laws Ann. § 400.111b(14). Moreover, “[a] provider shall not seek payment from the medically indigent individual, the family, or representative of the individual for . . . [a]uthorized services provided and reimbursed under the program.” Id. The restriction on a service provider prohibiting it from recovering the balance between its customary fee and the Medicaid payment is commonly referred to as the prohibition against “balance billing.” Palumbo v. Myers, 149 Cal. App. 3d 1020, 1025 (Cal. Ct. App. 1983). In this case, Spectrum is seeking enforcement of its lien on the settlement proceeds to recover $538,572.81, which it claims is the shortfall between its customary fee and the amount it already received from Medicaid. The Trust argues that the lien is balance billing and therefore, prohibited under the law. Upon review, we agree. All the courts which have considered the issue of whether a service provider, who has already accepted a Medicaid payment, may recover additional sums after a patient has received damages in a personal injury lawsuit have denied the provider’s claim. See Michael K. Beard, The Impact of Changes in Health Care Provider Reimbursement Systems on the Recovery of Damages for Medical Expenses in Personal Injury Suits, 21 Am. J. Trial Advoc. 453, 470 n.98 (1998). In Evanston Hospital v. Hauck, 1 F.3d 540, 542 (7th Cir. 1993), cert. denied, 510 U.S. 1091 (1994), a hospital provided a patient medical care in exchange for Medicaid reimbursement at the state’s prescribed rates. After the patient was awarded a sizable judgment against a third-party tortfeasor, the hospital sought to return the Medicaid amount and sue the patient for its customary fee. Id. at 542. In upholding the dismissal of the hospital’s suit, the Seventh Circuit stated: Nos. 04-1486/1541 Spectrum Health Continuing Care Group Page 9 v. Anna Marie Bowling Irrevocable Trust But Evanston Hospital was not “forced” to abandon its right to sue Hauck; no one coerced the hospital into cashing a [Medicaid] check from the taxpayers as partial reimbursement for Hauck’s medical bills. Rather, the hospital could have simply forsaken Medicaid and taken its chances that Hauck would somehow come up with the money to pay the bills himself. By opting for reimbursement from Medicaid, Evanston Hospital bought certainty. It purchased a guarantee of partial payment in lieu of possibly full payment or possibly no payment at all . . . Evanston Hospital wants out of its agreement with Medicaid now only because its gamble, in retrospect, was unwise. Id. The court explained that to permit recovery would be to transform Medicaid into “an insurance program for hospitals rather than for indigent patients,” because the hospital “wants to be reimbursed when the patient is indigent and still retain the right to sue patients who later become solvent — a classic example of wanting to both have and eat cake.” Id. at 544; see also Mallo v. Pub. Health Trust, 88 F. Supp. 2d 1376, 1387 (S.D. Fla. 2000) (holding that the balance-billing provision forces providers to make a calculated choice because once the provider has chosen Medicaid, it is “barred from billing the patient an amount in excess of the State’s Medicaid disbursement”). Similarly, in Palumbo v. Myers, a physician sued a patient to recover the difference between his customary fee and the Medicaid payment after the patient received a sizable settlement from a third-party tortfeasor, which included an allocation for the full payment of the fee. 149 Cal. App. 3d at 1022. The California appellate court held that though the third-party liability provisions of the Medicaid statute provide for the government’s recovery of its Medicaid expenditures, the prohibition against balance billing bars the physician’s claim. Id. at 1030; see also Lizer v. Eagle Air Med Corp., 308 F. Supp. 2d 1006, 1010 (D. Ariz. 2004) (holding that a provider, who has already accepted Medicaid, is prohibited from enforcing a lien against a third-party tortfeasor to recover its customary fee); Olszewski v. Scripps Health, 69 P.3d 927, 942 (Cal. 2003) (invalidating a state statute which authorized a provider to recover its customary fee through a lien against a judgment or settlement obtained by a Medicaid beneficiary against a third-party tortfeasor); Pub. Health Trust v. Dade County Sch. Bd., 693 So. 2d 562, 566 (Fla. Dist. Ct. App. 1997) (holding that a state regulation which permits a provider to recover its customary fee after receiving a Medicaid payment is invalid under Supremacy Clause). Applying these principles to this case, we conclude that the enforcement of Spectrum’s lien on the proceeds of the malpractice settlement to recover the balance of its customary fee is prohibited by federal and state law. Spectrum provided Bowling with medical care from May 1999 through September 2002, in exchange for which it received $101,021.86 from Medicaid. Spectrum was not required to seek payment from Medicaid; instead, Spectrum could have provided its services in exchange for enforcing its lien, which was the original agreement between the parties. Having chosen to accept payment from Medicaid however, Spectrum abandoned all rights to further recovery of its customary fee from the lien. As we have stated, Medicaid is a contract between a service provider and the government, in which the Medicaid recipient is a third-party beneficiary. Linton, 65 F.3d at 520. By accepting the Medicaid payment, the service provider accepts the terms of the contract — specifically that the Medicaid amount is payment in full. 42 U.S.C. § 1396a(a)(25)(C); 42 C.F.R. § 447.15; Mich. Comp. Laws Ann. § 400.111b(14). “If this arrangement is not acceptable to [service providers], they should not take Medicaid money in the first instance.” Evanston Hosp., 1 F.3d at 543. In its complaint, Spectrum states that it filed for Medicaid reimbursement because it was “[a]nticipating delay in realizing its lien on the medical malpractice lawsuit.” J.A. at 14 (Compl. at 3). Nothing in the statute, however, allows for the program to be used as a financing entity, providing interest-free loans to service providers until the beneficiary’s payment arrives. Congress Nos. 04-1486/1541 Spectrum Health Continuing Care Group Page 10 v. Anna Marie Bowling Irrevocable Trust certainly never intended such a result. Moreover, Spectrum also used Medicaid as an insurance policy against an adverse outcome of the malpractice litigation. As Dubinsky noted in his letter acknowledging the lien, “in the world of litigation, no result can be guaranteed.” J.A. at 19 (Letter from Dubinsky to Wayne Miller at 2 (Nov. 24, 1998)). Rather than risk the possibility of no recovery, Spectrum relied on the taxpayers to insure against a total loss. Similar to the Seventh Circuit, we reject the invitation to transform the Medicaid program “into an insurance program for hospitals rather than for indigent patients.” Evanston Hosp., 1 F.3d at 544. Spectrum attempts to distinguish its case from the other cases cited above by arguing that its lien pre-existed the malpractice settlement and that the lien was voluntarily agreed to by Bowling’s representatives. Appellee’s Br. at 26-27. Relying on contract principles, Spectrum concludes that it should be entitled to the benefit of its bargain. The district court agreed with this reasoning, explaining that we have “blessed such pre-existing agreements between providers and patients.”3 J.A. at 137 (Dist. Ct. Op. at 25). The district court’s reasoning however, omits the critical fact that there was a pre-existing agreement between Spectrum and the State of Michigan as well. If Spectrum had not received Medicaid payments, the lien would be enforceable against the Trust as a voluntary agreement entered into by willing parties, even though the patient was Medicaid-eligible. Barney, 110 F.3d at 1211. Once it accepted the Medicaid payment, however, Spectrum had been paid in full for the services provided to Bowling. The mere fact that a prior voluntary agreement existed is without consequence.4 The district court attempted to distinguish this case by arguing that Spectrum was not seeking to recover from Bowling or the Trust, but rather from the third-party tortfeasor alone. The dissent also relies on this distinction, noting that federal law only prohibits a service provider from seeking “to collect from the individual (or any financially responsible relative or representative of that individual) payment of an amount for that service.” 42 U.S.C. § 1395a(a)(25)(C). Similarly, Michigan law states that “[a] provider shall not seek payment from the medically indigent individual, the family, or representative of the individual.” Mich. Comp. Laws Ann. 3 In support of this statement, the district court cited our opinion in Barney in which we stated that “Medicaid providers may not bill patients for treatment under the program unless they have explicitly agreed prior to treatment that the patient will personally be liable, even if the providers themselves cannot get reimbursement from the state.” 110 F.3d at 1211. Spectrum also relies on the quoted statement from Barney in support of its argument that the lien should be enforced. Appellee’s Br. at 43. Both the district court and Spectrum read our statement in Barney beyond its appropriate context however. In Barney, we were referring to a provision under Ohio law which states that a Medicaid provider is “not required to bill the [state plan] for medicaid-covered services rendered to eligible consumers.” Ohio Admin. Code § 5101:3-1-13.1(C). Instead, the service provider may bill the consumer directly if “[t]he consumer is notified in writing prior to the service being rendered that the provider will not bill the [state plan] for the covered service; and . . . [t]he consumer agrees to be liable and signs a written statement to that effect prior to the service being rendered.” Id. Thus, the statement in Barney stands for the unremarkable proposition that parties may elect to contract for services outside of the Medicaid scheme even though the services provided are otherwise covered by Medicaid and the consumer is Medicaid-eligible. The Barney statement does not apply to a situation as in this case, where the service provider both contracted with the consumer for medical services and billed Medicaid for those same services. 4 At oral argument, Spectrum also claimed that the balance of equities favors enforcing the lien because Dubinsky used Spectrum’s customary fee to obtain a larger settlement in the medical-malpractice suit. Spectrum argues that it would be unfair to allow a party to negotiate a settlement amount based on the validity of the lien and then later claim the lien is unenforceable. We find this argument to be equally unpersuasive. First, there is no evidence in the record that Spectrum’s customary fee necessarily increased the settlement amount. Indeed, had Dubinsky not used Spectrum’s customary fee in the negotiations, the estimate of the medical expenses incurred could have been substantially larger. Second, it was Spectrum’s choice to apply for and accept Medicaid payments, and thereby implicate Medicaid’s balance-billing prohibition. Spectrum’s claim that the Trust is a bad actor seeking to renege on a promise is without merit. A party is not entitled to the benefit of its bargain when enforcement of that bargain would violate federal and state law. Nos. 04-1486/1541 Spectrum Health Continuing Care Group Page 11 v. Anna Marie Bowling Irrevocable Trust § 400.111b(14). Citing the California Supreme Court’s decision in Olszewski v. Scripps Health, the dissent reasons that because the settlement allocated a portion of the proceeds for payment of the lien, enforcement is not prohibited by the balance-billing prohibition. In further support of this reasoning, Spectrum cites the Eighth Circuit’s recent decision in Ahlborn v. Ark. Dep’t of Human Servs., 397 F.3d 620, 627 (8th Cir. 2005), for the proposition that a portion of a settlement award may be recoverable if specifically allocated for medical expenses. Upon review, we conclude this argument is unpersuasive as well. First, while the dissent is correct that the federal and state statutes only mention attempts to recover from the individual or his or her representative, Spectrum’s lien on the settlement proceeds is seeking recovery from Bowling for her medical care, and therefore falls within this prohibition. Despite the line item allocation to Spectrum in the settlement agreement, Spectrum was not a party to the medical malpractice suit and the settlement allocation is not its property. Similarly, once the settlement has been approved, the settlement proceeds are no longer the property of the tortfeasor either. Instead, the entirety of the settlement, regardless of how5it is allocated, belongs to Bowling; Spectrum’s lien is merely an encumbrance upon that property. See Black’s Law Dictionary 933 (7th ed. 1999) (defining a lien as “[a] legal right or interest that a creditor has in another’s property, lasting usu[ally] until a debt or duty that it secures is satisfied”); see also In re Approximately Forty Acres in Tallmadge Township, 566 N.W.2d 652, 657 (Mich. Ct. App. 1997) (“A lien is a security interest for money owed by one party to another, and is separate from an underlying cause of action.” (internal citation omitted)); Aetna Cas. & Sur. Co. v. Starkey, 323 N.W.2d 325, 328 (Mich. Ct. App. 1982) (“A lien is not a property right in, or right to, the thing itself, but constitutes a charge or security thereon.”). Therefore, by seeking to enforce its lien, Spectrum is attempting to recover its customary fee from the Medicaid patient herself in clear violation of both federal and state law. Furthermore, the federal and state statutes outlining Medicaid’s balance-billing prohibition cannot be read in isolation. The federal regulation accompanying the statute explicitly limits participation in the Medicaid program to “providers who accept, as payment in full, the amounts paid by the agency.” 42 C.F.R. § 447.15 (emphasis added). Similarly, the Michigan statute states that “a provider shall accept payment from the state as payment in full by the medically indigent individual for services received.” Mich. Comp. Laws Ann. § 400.111b(14) (emphasis added). The clear import of these words is that the Medicaid payment is the total amount owed to the provider for the services rendered, and thus the provider “may not attempt to recover any additional amounts elsewhere.” Rehab. Ass’n of Va., Inc. v. Kozlowski, 42 F.3d 1444, 1447 (4th Cir. 1994), cert. denied, 516 U.S. 811 (1995); see also Lizer, 308 F. Supp. 2d at 1009 (“This language prevents providers from billing any entity for the difference between their customary charge and the amount paid by Medicaid.”). There is nothing in the statutes or regulations which suggests that a service provider may recover additional payment for those services. 5 Spectrum’s reliance on the Eighth Circuit’s recent decision in Ahlborn v. Ark. Dep’t of Human Servs., 397 F.3d 620 (8th Cir. 2005), is also misplaced. Ahlborn involved a claim by the state for reimbursement for Medicaid payments from a personal-injury settlement. Id. at 621. Where a third party is liable for the cost of a Medicaid recipient’s health care, federal law specifically assigns the state plan “the rights of such individual to payment by any other party for such health care items or services.” 42 U.S.C. § 1396a(a)(25)(H). Federal law defines the assignment to the state as the right “to payment for medical care from any third party.” 42 U.S.C. § 1396k(a)(1)(A). Recognizing that a settlement agreement often contains compensation for other expenses beyond simply medical care, the Eighth Circuit held that under these statutory provisions, the state’s recovery is limited to the portion of the settlement allocated for medical expenses, even if that amount is below the actual cost incurred by the state. Id. at 627-28. The state may not recover from portions of the settlement not allocated for medical care. Id. at 628. Despite Spectrum’s arguments to the contrary, Ahlborn does not stand for the proposition that allocated settlement proceeds are the property of the lienor rather than the tort victim. Nos. 04-1486/1541 Spectrum Health Continuing Care Group Page 12 v. Anna Marie Bowling Irrevocable Trust The dissent concedes the reasonableness of this interpretation, but nevertheless reads into the law ambiguity where there is none in order to justify an alternative interpretation. In support of its argument, the dissent, like the district court below, relies heavily on a 1997 opinion letter from the Acting Director of the Medicaid Bureau of the Health Care Financing Administration (“HCFA”), which the California Supreme Court discussed in Olszewski: In the letter, the acting director stated that “[f]ederal law would not preclude the practice of providers pursuing payment in tort situations in excess of Medicaid reimbursement” as long as a state satisfies two conditions. First, the state must assure that Medicaid is made whole before the provider recovers any money. Second, the state must protect the assets of Medicaid beneficiaries by limiting provider recovery to the portion of the award specifically allocated for the beneficiary’s medical expenses. 69 P.3d at 943. The dissent argues that there is “no reason to suppose that the Medicaid Bureau’s clarification does not still represent agency policy, entitled to respectful consideration by the courts.” Dissent at 16. Therefore, the dissent concludes that because the two conditions are met, the lien does not violate federal law. But see Palumbo, 149 Cal. App. 3d at 1022 (holding that a service provider was prohibited from collecting from a third-party tortfeasor even after Medicaid had been reimbursed and the settlement allocated funds for the full customary amount of medical expenses). We believe that such heavy reliance on this opinion letter in the face of clear statutory and regulatory language is misplaced. First, the letter, dated June 9, 1997, is not included in the record. It is neither listed on the website for the Centers for Medicare & Medicaid Services, the successor to HCFA, nor published elsewhere. See http://www.cms.hhs.gov/states/letters/ (listing agency letters written to state officials from 1994-2004). Indeed, the lack of public availability alone raises doubts about whether this eight-year old opinion letter is still the policy of the federal government. Moreover, the agency’s letter is not entitled to judicial deference. The letter does not appear to be a product of the agency’s rule-making authority, and therefore was likely not subject to the rigors of the public notice-and-comment process. See United States v. Mead Corp., 533 U.S. 218, 230 (2001) (holding that agency action resulting from notice-and-comment rule-making or formal adjudications is entitled to judicial deference). Likewise, nothing in the Medicaid statutory scheme reveals that Congress intended that courts defer to the agency’s opinion letters. Id. at 231 (noting that the absence of administrative formality does not necessarily bar judicial deference if Congress intended informal interpretations to have the force of law). Instead, as the Supreme Court has held, “[i]nterpretations such as those in opinion letters — like interpretations contained in policy statements, agency manuals, and enforcement guidelines, all of which lack the force of law — do not warrant Chevron-style deference.” Christensen v. Harris County, 529 U.S. 576, 587 (2000); see also Wis. Dep’t of Health & Family Servs. v. Blumer, 534 U.S. 473, 497 (2002) (holding that the HCFA’s interpretation of a federal statute outlined in a regional letter to state directors as well as a proposed rule only “warrants respectful consideration”). The sole exception to this rule is where an agency is seeking to interpret its own regulation, and the language of that regulation is ambiguous. Christensen, 529 U.S. at 588 (citing Auer v. Robbins, 519 U.S. 452, 461 (1997)); Beck, 390 F.3d at 919. In this case, however, there is nothing ambiguous about the language of the federal regulation, which limits “participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the [state Medicaid agency].” 42 C.F.R. § 447.15. Moreover, the opinion letter does not serve to clarify anything about the language of that regulation, but instead authorizes reimbursement of a provider’s customary fee from third-party tortfeasors. Thus, “[t]o Nos. 04-1486/1541 Spectrum Health Continuing Care Group Page 13 v. Anna Marie Bowling Irrevocable Trust defer to the agency’s position would be to permit the agency, under the guise of interpreting a regulation, to create de facto a new regulation.”6 Christensen, 529 U.S. at 588. Finally, the letter is inconsistent with the statutory scheme Congress enacted. To the extent that a third party is liable for the medical expenses of a Medicaid beneficiary, federal law requires that the beneficiary assign his or her right to payment from the third party for medical expenses to the state Medicaid agency. 42 U.S.C. §§ 1396a(a)(25)(H), 1396k(a)(1)(A); see also Ahlborn, 397 F.3d at 625 (noting that the statutory scheme requires the state to be reimbursed for its Medicaid payments from third parties who are liable to the Medicaid beneficiary). Thus, Congress clearly envisioned a scenario in which a third party would be liable to a Medicaid beneficiary for medical services, but specifically authorized recovery only to the state agency. The absence of a statutory provision providing for recovery for service providers of their customary fee coupled with the language limiting service providers to Medicaid payments as payment in full, reinforces our conclusion that the approach in the 1997 opinion letter should not be adopted. See Gozlon-Peretz v. United States, 498 U.S. 395, 404 (1991) (“[W]here Congress includes particular language in one section of a statute but omits it in another section of the same Act, it is generally presumed that Congress acts intentionally and purposely in the disparate inclusion or exclusion.” (internal citation omitted) (alteration in original)). In sum, because we hold that the language of the federal regulation and Michigan law clearly limit service providers to the amount paid by the7Medicaid agency as “payment in full,” we decline to follow the 1997 letter’s suggested approach. See Christensen, 529 U.S. at 588 (declining to adopt an agency interpretation of an unambiguous regulation). Moreover, given the extremely detailed nature of the Medicaid scheme and the frequency with which it is amended, reliance on an 6 By contrast, the district court below found that the “policy clarification letter is a policy directive entitled to considerable deference.” J.A. at 133 (Dist. Ct. Op. at 21 n.8). The court cited Elizabeth Blackwell Health Center For Women v. Knoll, 61 F.3d 170 (3d Cir. 1995), cert. denied, 516 U.S. 1093 (1996), in support of its argument. In Elizabeth Blackwell, the Third Circuit held that a letter to state Medicaid directors from the Director of the HCFA was entitled to “considerable weight.” Id. at 182. The letter in that case both interpreted a federal statute as well as clarified one of HCFA’s own regulations. Id. at 177, 183. To the extent that the Third Circuit’s opinion in Elizabeth Blackwell can be read as deferring to an agency’s policy letter regarding the interpretation of a federal statute, the Supreme Court has twice since that decision clarified the degree of judicial deference due to informal agency pronouncements. See Mead Corp., 533 U.S. at 235 (holding that tariff classification rulings by the United States Customs Service are only to be considered persuasive authority); Christensen, 529 U.S. at 587 (holding that an opinion letter written by the Department of Labor interpreting a statute is not entitled to Chevron deference). More specifically, in the context of Medicaid, the Court has stated that the HCFA’s interpretation of a federal statute outlined in both a regional state letter and a proposed rule is entitled to only “respectful consideration.” Blumer, 534 U.S. at 497. Therefore, Elizabeth Blackwell is no longer the last word on this point. As to the portion of the Elizabeth Blackwell letter that simply clarified an ambiguity in a previously promulgated rule, the HCFA letter in Elizabeth Blackwell is entitled to judicial deference under the Auer exception. Because the regulation at issue in this case is unambiguous, this portion of the Elizabeth Blackwell opinion is not applicable to the case at bar either. 7 Spectrum also relies on a letter from the Supervisor of the Casualty Unit in the Michigan Department of Community Health, in which she writes that “there is case law (no-fault) supporting a provider’s right to payment of all charges when they have asserted a lien directly with the insurance company, even when they have also billed and received payment from Medicaid.” J.A. at 102 (Letter from Patricia Morscheck to Wayne J. Miller at 1 (Apr. 16, 2003)). The letter does not provide any citations to a case in which a Medicaid provider has recovered its customary fee from a settlement with a tortfeasor. Moreover, to the extent that Ms. Morscheck’s opinion is relying on the reimbursement practice under the state’s no-fault statute, it is inapposite to this case. Michigan’s no-fault statute specifically authorizes payment to providers of their customary charges. See Mich. Comp. Laws Ann. § 500.3157 (requiring service providers to charge a reasonable amount not to exceed its customary charges); Munson Med. Ctr. v. Auto Club Ins. Ass’n, 554 N.W.2d 49, 53 (Mich. Ct. App. 1996) (holding that under the state’s no-fault law, a service provider is entitled to customary charges it bills every patient treated rather than amount it accepts). Finally, because we find the federal and state statutes to be clear, we need not rely on the guidance from the state agency official. Nos. 04-1486/1541 Spectrum Health Continuing Care Group Page 14 v. Anna Marie Bowling Irrevocable Trust eight-year-old opinion letter paraphrased by the Supreme Court of California is unwarranted. If service providers should be permitted to recover their customary fees from a beneficiary’s settlement with a third-party tortfeasor, it is solely within the province of Congress to allow it. For now, we will adhere to the clear language of the statute and the accompanying regulation. Therefore, the Trust is entitled to judgment as a matter of law.