Florida District Court Determines Statute of Limitations for Suits Under the MSPA


In MSPA Claims 1, LLC, v. Kingsway Amigo Insurance Company, the defendant, Kingsway Amigo Insurance Company (Kingsway), argues that the plaintiff’s MSPA claim is barred by the statute of limitations.

The plaintiff, MSPA Claims 1, LLC (“Claims 1”), was assigned all subrogation claims, recovery and reimbursement rights against any liable primary payer originally belonging to Florida Healthcare Plus, a Medicare Advantage Organization (MAO). In April 2012, a Kingsway insured was involved in an accident with a Medicare enrollee who sustained injuries. Florida Healthcare Plus made payments for medical treatment related to the enrollee’s injuries. The enrollee later settled her claim with Kingsway, triggering Kingsway’s obligation as a primary payer to reimburse conditional payments made by Florida Healthcare Plus. As the assignee of Florida Healthcare Plus’s subrogation rights, Claims 1 brought a claim against Kingsway under the Medicare Secondary Payer Act (MSPA).

Kingsway argued that Claims 1’s action should be dismissed under the limitations period set out in Section 1395y(b)(2)(B)(vi) of the MSPA. This section states that reimbursement may be sought “within the 3-year period beginning on the date on which the item or service was furnished.” Therefore, according to Kingsway, the limitations period would begin running from the date of service. Using this standard, Claims 1’s action would be barred.

Claims 1 argued, however, that the applicable limitations period is found in Section 1395y(b)(2)(B)(iii) of the MSPA. This section states that an action may be filed under the MSPA “not later than 3 years after the day of the receipt of notice of a settlement, judgment, award, or other payment.” Claims 1 argues that it had three years from the date on which it became aware of Kingsway’s settlement to bring the suit and, therefore, the claim was timely filed.

The court determined that Section (B)(iii) of the MSPA specifically contemplates litigation, whereas Section (B)(vi) merely sets out a timeframe for the government to request reimbursement. Holding in favor of Claims 1, the court found that the suit was timely filed and allowed the action to proceed.

#Florida #PrimaryPayer #statuteoflimitations #MSPA

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