Alpha Thirteen, LLC v. Geico Casualty Company, Progressive Preferred Insurance Company, and Amberly Montanez

CourtDistrict Court, D. Utah
DecidedMay 26, 2026
Docket2:25-cv-00488
StatusUnknown

This text of Alpha Thirteen, LLC v. Geico Casualty Company, Progressive Preferred Insurance Company, and Amberly Montanez (Alpha Thirteen, LLC v. Geico Casualty Company, Progressive Preferred Insurance Company, and Amberly Montanez) is published on Counsel Stack Legal Research, covering District Court, D. Utah primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alpha Thirteen, LLC v. Geico Casualty Company, Progressive Preferred Insurance Company, and Amberly Montanez, (D. Utah 2026).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF UTAH

ALPHA THIRTEEN, LLC, MEMORANDUM DECISION AND ORDER GRANTING [35] DEFENDANT Plaintiff, PROGRESSIVE PREFERRED INSURANCE COMPANY’S MOTION v. TO DISMISS, [43] DEFENDANT GEICO CASUALTY COMPANY’S MOTION TO GEICO CASUALTY COMPANY, DISMISS, AND [44] DEFENDANT PROGRESSIVE PREFERRED INSURANCE AMBERLY MONTANEZ’S MOTION COMPANY, and AMBERLY MONTANEZ, FOR JUDGMENT ON THE PLEADINGS

Defendants. Case No. 2:25-cv-00488-DBB-DBP

District Judge David Barlow

Before the court is Defendant Geico Casualty Company’s (“GEICO”) Motion to Dismiss and Defendant Progressive Preferred Insurance Company’s (“Progressive”) Motion to Dismiss Plaintiff Alpha Thirteen, LLC’s (“Alpha”) Amended Complaint, as well as Defendant Amberly Montanez’s (collectively, “Defendants”) Motion for Judgment on the Pleadings.1 For the reasons stated below, the court grants Defendants’ motions.2 BACKGROUND Medicare and Medicare Advantage

1 Def. Progressive’s Mot. to Dismiss (“Progressive Mot.”), ECF No. 35, filed Dec. 9, 2025; Def. GEICO’s Mot. to Dismiss (“GEICO Mot.”), ECF No. 43, filed Dec. 30, 2025; Def. Amberly Montanez’s Mot. for J. on the Pleadings (“Montanez Mot.”), ECF No. 44, filed Jan. 5, 2026. 2 Because Defendants’ motions raise largely similar arguments for dismissal of all claims, the court addresses Defendants’ arguments together unless otherwise indicated. Medicare is a “federally funded health insurance program for the elderly and disabled.”3 Enacted by Congress in 1965, Medicare consists of five parts.4 Parts A and B contain the “traditional” Medicare model in which the federal government reimburses medical providers directly for hospital and outpatient medical care.5 Part C contains the Medicare Advantage program, which uses a different model and allows Medicare-eligible individuals to have a Medical Advantage Organization (“MAO”) provide their Medicare benefits.6 Part D provides prescription drug coverage, and Part E lists Medicare’s definitions and exclusions, one of which is the Medicare Secondary Payer Act (“MSP Act”).7 Part E also contains a cause of action that is “expressly reserved for the United States” and a second “private cause of action” that is at issue in this case.8

Part C’s “Medicare Advantage system is a public-private health insurance system that runs parallel to Medicare”9 The first iteration of it—entitled “Medicare + Choice”—was enacted in 1997 to “allow beneficiaries to have access to a wide array of private health plan choices in addition to traditional fee-for-service Medicare,” and to “enable the Medicare program to utilize innovations that have helped the private market contain costs and expand health care delivery options.”10 One type of “downstream actor” that operates in this system is an independent physician association (“IPA”).11 An “IPA is a group of independent physicians that contract with

3 Thomas Jefferson Univ. v. Shalala, 512 U.S. 504, 506 (1994); 42 U.S.C. § 1395 et seq. 4 See Aetna Life Ins. Co. v. Big Y Foods, Inc., 52 F.4th 66, 68 (2d Cir. 2022). 5 42 U.S.C. § 1395w-22(a)(1). See Big Y Foods, Inc., 52 F.4th at 68; MaxMed Healthcare, Inc. v. Price, 860 F.3d 335, 337 (5th Cir. 2017). 6 42 U.S.C. § 1395w-22(a). 7 See Big Y Foods, Inc., 52 F.4th at 68. 8 42 U.S.C. § 1395y(b)(3)(A). 9 MSP Recovery Claims, Series LLC v. ACE Am. Ins. Co., 974 F.3d 1305, 1308 (11th Cir. 2020). 10 H.R. Rep. No. 105-217, at 585 (1997) (Conf. Rep.). 11 ACE Am. Ins. Co., 974 F.3d at 1309. one or more insurers to provide medical care for a population of insureds.”12 An IPA “serves as

an intermediary between an MAO and medical service providers.”13 They are designed to “negotiate with health insurance carriers and other health care payor organizations to establish arrangements for their member physicians to be considered preferred providers by the payors.”14 “To operate more nimbly and to better compete with Medicare, some MAOs contract with smaller organizations, like independent physician associations, that have closer connections to local healthcare providers.”15 So long as MAOs provide the same benefits to beneficiaries they would receive under traditional Medicare,16 the federal government “pays MAOs a fixed, per capita payment and leaves it to the MAOs to pay their insureds’ expenses as they arise.”17 This arrangement gives

MAOs flexibility but also exposes them to the risk that their expenditures will exceed their revenues because their payment from the government is fixed.18 MAOs pay claims from their assets rather than the Trust Fund.19 Secondary-payer Status Medicare was initially the primary payer for medical services, even if Medicare beneficiaries also had private insurance.20 In 1980, however, Congress “inverted that system”

12 “Accountable Care Organizations & the Medicare Shared Savings Program,” Cong. Res. Serv. (May 26, 2011) at 7 n.33, https://www.congress.gov/crs-product/R41474 [https://perma.cc/AS3Q-EYGC]. 13 ACE Am. Ins. Co., 974 F.3d at 1310. 14 Pfenninger v. Exempla, Inc., 116 F. Supp. 2d 1184, 1187–88 (D. Colo. 2000). 15 ACE Am. Ins. Co., 974 F.3d at 1308. 16 See 42 U.S.C. § 1395w-22(a). 17 Humana Med. Plan, Inc. v. W. Heritage Ins. Co., 880 F.3d 1229, 1291 (11th Cir. 2018) [hereinafter Humana II] (denying rehearing en banc) (Tjoflat, J., dissenting). 18 See id. at 1292. 19 Id. 20 See Bio-Med. Applications of Tenn., Inc. v. Cent. States Se. & Sw. Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011). when it enacted the MSP Act, which made Medicare the secondary payer in an attempt to control Medicare’s rising costs.21 Two years later, Congress further amended the Medicare statute by creating a “private cause of action” to recover double damages if a primary insurer “fails to provide for primary payment (or appropriate reimbursement) in accordance with paragraphs (1) and (2)(A).”22 Paragraph (1) of that provision regards primary healthcare coverage through an employer or other sponsor and is not at issue here. However, Paragraph (2)(A) is relevant because it prohibits Medicare from bearing the cost of services under the following conditions: (i) payment has been made, or can reasonably be expected to be made, with respect to the item or service as required under paragraph (1), or

(ii) payment has been made or can reasonably be expected to be made under a workmen’s compensation law or plan of the United States or a State or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no fault insurance.23 “These provisions protect Medicare from being required to pay for services for which a primary plan is responsible.”24 When a primary payer is “has not made or cannot reasonably be expected to make payment” for medical care, Subparagraph (B) authorizes Medicare to make conditional payments, subject to reimbursement.25 In 2003, Congress updated Medicare Advantage largely to address secondary payer issues.26 42 U.S.C. § 1395w-22(a)(4) establishes MAOs as secondary payors “under circumstances in which payment is made secondary pursuant to section 1395y(b)(2) of this

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Alpha Thirteen, LLC v. Geico Casualty Company, Progressive Preferred Insurance Company, and Amberly Montanez, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alpha-thirteen-llc-v-geico-casualty-company-progressive-preferred-utd-2026.