#USDistrictCourt

Melisa Zwilling

Jul 16, 2018

U.S. District Court Sanctions MSP Recovery and Counsel for Misstatement in Pleadings

We are continuing to monitor the nationwide string of suits filed by MAO-MSO Recovery II, LLC and MSP Recovery, LLC (“Plaintiffs”) against multiple insurance carriers. As you may recall, Plaintiffs filed putative class action suits claiming to be assignees of recovery rights originally held by Medicare Advantage Organizations (“MAO”) under the Medicare Secondary Payer Act (“MSPA”). Recently, the United States District Court for the Central Division of Illinois sanctioned MSP

District Court Affirms Medicare Advantage Organization’s Right to Sue Primary Plans Pursuant to the

Melisa Zwilling

Apr 6, 2018

District Court Affirms Medicare Advantage Organization’s Right to Sue Primary Plans Pursuant to the

A U.S. District Court followed the trend of permitting a Medicare Advantage Organization (“MAO”) to sue pursuant to the Medicare Secondary Payer Act’s (“MSPA”) Private Cause of Action (“PCOA”) provision. In Aetna Life Ins. Co. v. Guerrera, Aetna, a MAO, paid medical expenses on behalf of a Medicare beneficiary after he sustained personal injuries at a grocery store. After Aetna notified the defendant-grocery store of its lien, the grocery store settled and issued payment to t

Fifth Circuit District Court Allows MAO Action Seeking Reimbursement from Tort Settlement Fund to Go

Melisa Zwilling

Apr 6, 2018

Fifth Circuit District Court Allows MAO Action Seeking Reimbursement from Tort Settlement Fund to Go

On March 16, 2018, the United States District Court for the Southern District of Texas denied defendant’s Motion to dismiss in Humana, Inc. v. Shrader Sc Associates, LLP., 2018 U.S. Dist. LEXIS 43884, *13. The matter originated from a suit by Humana, Inc., United Healthcare Services, Inc., and Aetna, Inc. (“Plaintiffs”) for reimbursement from settlement funds being held by law firm Shrader & Associates, LLP (“Shrader”). Shrader represented several claimants who suffered asb

11th Circuit District Court: MAO Action Against Treatment Provider Under PCOA Provision of MSP May P

Melisa Zwilling

Mar 29, 2018

11th Circuit District Court: MAO Action Against Treatment Provider Under PCOA Provision of MSP May P

A U.S. District Court for the Southern District of Florida recently held that a Medicare Advantage Organization (MAO) may bring an action against a provider for double damages under the private cause of action provision of the Medicare Secondary Payer Act (MSP). While we have seen numerous cases from Medicare Advantage Organizations against primary insurers, a claim against a treatment provider under the MSP is something that this Court had not yet considered. In MSPA Claims

U.S. District Court Holds that a Plaintiff Must Exhaust Administrative Proceedings Prior to Judicial

Melisa Zwilling

Mar 23, 2018

U.S. District Court Holds that a Plaintiff Must Exhaust Administrative Proceedings Prior to Judicial

A U.S. District Court affirmed that a plaintiff must exhaust the administrative appeals process before seeking a declaratory judgment that Medicare is not entitled to recover conditional payment claims. In Weiss v. Price, the Plaintiff filed a medical malpractice suit, following the death of her husband, alleging two claims: (i) a wrongful death claim, in her individual capacity, and (ii) a survivorship claim, on behalf of the Estate. The state court judge allocated all settl

U.S. District Court Again Follows Eleventh Circuit Decision Finding that the Existence of a Contract

Melisa Zwilling

Mar 31, 2017

U.S. District Court Again Follows Eleventh Circuit Decision Finding that the Existence of a Contract

MSP Recovery, LLC v. Allstate Ins. Co., No. 15-21532, 2017 U.S. Dist. LEXIS 41424 (U.S. Dist. S.D. Fla., March 21, 2017) was recently back before the United States District Court for the Southern District of Florida, again on a motion to dismiss. As you may recall, this case was one of the seven consolidated cases included in the Eleventh Circuit decision finding that a contractual obligation alone could satisfy the “demonstrated responsibility” requirement of the private cau

U.S. District Court Again Relies on Eleventh Circuit Decisions And Allows Medicare Advantage Organiz

Melisa Zwilling

Mar 31, 2017

U.S. District Court Again Relies on Eleventh Circuit Decisions And Allows Medicare Advantage Organiz

In the recent case, Mspa v. Century Sur. Co., No. 16-20752, 2017 U.S. Dist. LEXIS 37040 (U.S. Dist. S.D. Fla., March 15, 2017), the United States District Court for the Southern District of Florida once again considered the rights of Medicare Advantage Organizations (MAOs) to seek reimbursement of medical expenses under the Medicare Secondary Payer Act (MSP). In this case, the enrollee of Florida Healthcare Plus, a Medicare Advantage Organization (MAO), was injured on propert

District Court Grants Motion to Dismiss After U.S. Argues that Court Lacks Jurisdiction Over Medicar

Melisa Zwilling

Nov 15, 2016

District Court Grants Motion to Dismiss After U.S. Argues that Court Lacks Jurisdiction Over Medicar

In Cheryl Nelson & Geico Gen. Ins. Co. v. Medi-Cal., No. 1:16-cv-01328-LJO-BAM, 2016 U.S. Dist. Ct. LEXIS 153596 (E.D. Cal., November 4, 2016), the Plaintiffs (Geico General Insurance Company and Cheryl Nelson) brought an action for an interpleader of funds. The Plaintiffs intended on resolving competing claims by twelve entities against a $100,000.00 motor vehicle accident insurance settlement which was to be paid to the injured party. Plaintiffs alleged that they were unabl

US District Court Approves Split of Settlement Funds between CMS and TriCare

Melisa Zwilling

Oct 26, 2016

US District Court Approves Split of Settlement Funds between CMS and TriCare

The present action, Geico Gen. Ins. Co. v. Dep’t of the Navy Med. Care Recovery Unit, arises out of a motor vehicle accident where June Shaw, an occupant of the vehicle was severely injured when Cecil Shaw had a medical event that led to the accident. Ms. Shaw was both a Medicare and TriCare beneficiary. As a beneficiary of both entities, Ms. Shaw was entitled to treatment on the condition that Medicare and TriCare would be reimbursed after settlement for payment of accident-

US District Court: Ruling in Sexton vs. Medicare

Melisa Zwilling

Aug 1, 2016

US District Court: Ruling in Sexton vs. Medicare

In Sexton v. Medicare, 2016 U.S. Dist. LEXIS 89818, Medicare made conditional payments for Plaintiff’s treatment after Plaintiff was injured in a motor vehicle accident. After the conditional payments were made, Medicare issued a conditional payment letter to Plaintiff notifying him that Medicare had paid $678.80 for treatment of his accident-related injuries and that he may be required to reimburse Medicare for medical expenses related to his liability claim in the future. T

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