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U.S. District Court Upholds Dismissal of Claim Brought Under the Private Cause of Action Provision o


In the present case, Claims v. Co. V., No. 16-20338-CIV-LENARD/GOODMAN, 2017 U.S. Dist. Ct. LEXIS 43755, the Plaintiff (MSPA Claims 1, LLC) alleges that the Defendant (Covington Specialty Insurance Company) violated the Medicare Secondary Payer Act (MSP) by failing to reimburse payments made by a beneficiary’s Medicare Advantage Plan (MAP) provider for medical expenses incurred related to an accident for which Defendant was the primary payer. The Defendant insurer provided a no-fault insurance policy to the beneficiary. The Plaintiff argued that the MAP had validly assigned its right of reimbursement under the MSP to La Ley who in turn assigned it to the Plaintiff.

The Court had previously granted the Defendant’s Motion to Dismiss the Plaintiff’s claim for lack of standing on factual grounds as the case was invalidly assigned to the Plaintiff. The MAP had repudiated its agreement with La Ley prior to the assignment of the claim to Plaintiff and, thus, the Plaintiff lacked standing at the time it filed its complaint. The Plaintiff subsequently filed the present Motion for Leave to Amend and Motion for Rehearing and/or Reconsideration of the Court’s September 30, 2016 Order Granting Defendant’s Motion to Dismiss and Closing Case.

In support of its motions, the Plaintiff specifically pointed to the recent Eleventh Circuit decision in MSP Recovery, LLC v. Allstate Ins. Co., 2016 U.S. App. Lexis 15984, arguing that the controlling law had changed. However, the Court points out that the Eleventh Circuit decision was rendered before it issued its prior Order dismissing the claim. Additionally, the Court pointed out that the Eleventh Circuit case did not involve a repudiation of the agreement between the MAP and assignee and thus, a different question is before the Court in this particular case. After considering a number of other procedural arguments made by the Plaintiff, the Court reviewed the history of the case and the relevant law and denied the Plaintiff’s motions on procedural grounds.

#MedicareSecondaryPayer #MedicareAdvantagePlan #EleventhCircuit

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