Auto Club Insurance v. United States

103 Fed. Cl. 268, 2012 U.S. Claims LEXIS 28, 2012 WL 184150
CourtUnited States Court of Federal Claims
DecidedJanuary 24, 2012
DocketNo. 11-256 C
StatusPublished
Cited by4 cases

This text of 103 Fed. Cl. 268 (Auto Club Insurance v. United States) is published on Counsel Stack Legal Research, covering United States Court of Federal Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Auto Club Insurance v. United States, 103 Fed. Cl. 268, 2012 U.S. Claims LEXIS 28, 2012 WL 184150 (uscfc 2012).

Opinion

OPINION

DAMICH, Judge:

Plaintiff, a Michigan no-fault automobile insurance corporation, seeks reimbursement from the federal government of its payment of the prescription medication expenses of one of its insureds injured in a motor vehicle accident in February 1980. The insured became eligible for Medicare health coverage in 2005 and for its Part D prescription drags benefit in 2006, but the medication expenses have continued to be paid in the first instance by Plaintiff as required by Michigan’s no-fault automobile insurance statute.

Plaintiff argues, however, that, under the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2) (“MSPA” or “the Act”), effective December 5, 1980, and implementing regulations of the Centers for Medicare and Medicaid Services (“CMS”), Medicare is the primary insurer for medical expenses for accidents that occurred prior to the Act. Plaintiff reasons that the Act and its regulations provide “for a system and regimen allocating the rights and responsibilities as between CMS and the other [insurance] payers” and that a “right of reimbursement” exists “when a no-fault insurer has paid an item that the law provides is the primary obligation of the Medicare program.” PL’s Br. in Opp’n to Def.’s Mot. to Dismiss (“PL’s Resp.”) at 2, 3.

The Government has moved to dismiss for lack of subject matter jurisdiction, arguing that the MSPA is not a money-mandating statute nor has Plaintiff demonstrated an implied contract within the terms of the Tucker Act’s limited waiver of the bar of sovereign immunity.

For the reasons stated below, Defendant’s motion to dismiss is granted.

I. Background

The individual whose medical expenses are the subject of Plaintiffs claim, identified in the complaint as “V.R.,” was injured in a motor vehicle accident in February 1980. He (or she) was insured by Plaintiff, a reciprocal insurance company organized under the laws of Michigan. “[A]s such the coverage afforded under the Auto Club policy was governed by the requirements of the Michigan No-fault Automobile Insurance Act (No-fault Act), Public Act 294 (1972), as amended.” Compl. ¶ 7.

According to Plaintiff,

[u]nder Michigan law, when an insured’s medical expenses are submitted to a no-fault automobile insurance carrier, that carrier must pay those expenses, even if properly payable, in whole or in part, by other coverage or resources. If there are issues relating to coverage or priority, the [270]*270no-fault insurer’s obligation is to pay the item, and then seek repayment or reimbursement from other coverage or resources.

Id. ¶ 10.

Once V.R. became eligible for coverage under Medicare in 2005 and, in particular, for Medicare’s Part D prescription benefits coverage in 2006, because his (or her) accident occurred prior to the December 1980 effective date of the MSPA, Plaintiff alleges, the primary responsibility for his health expenses became that of Medicare. The Michigan no-fault carriers, however, “are not permitted to deny coverage when the expenses — properly payable by Medicare — are submitted to them for payment by the providers.” Pl.’s Resp. at 6.

Plaintiff thus has turned to this court to enforce what it asserts is Medicare’s “obligation of reimbursement”; otherwise, “No-fault automobile insurers in Michigan are caught on the horns of a major dilemma, in the very small number of Medicare cases that include this one.”1 Id.

Plaintiff concedes that, under the MSPA, Medicare is the secondary payor, and the insurer the primary, of medical expenses from motor vehicle accidents occurring on or after December 5, 1980. According to Plaintiff, CMS clarified by regulation in 1983, however, “that the MSP program does not apply to persons who are receiving medical treatment at any time, if it arises from a motor vehicle accident which occurred before December 5,1980.” Id. at 5. Auto Club thus alleges that it has paid expenses on V.R.’s behalf, stemming from a pre-December 1980 accident, that since 2005 are properly the responsibility of Medicare and for which Auto Club seeks reimbursement. Plaintiffs dilemma is that “CMS has not established any administrative process for the submission of reimbursement claims of this nature.” Id. at 4.

Plaintiff founds its claim against the Government, therefore, on the MSPA and the regulations adopted by CMS under the Act. It also argues that the Act and its regulations constitute an implied contract between CMS and no-fault insurers. The Government has moved to dismiss for lack of subject-matter jurisdiction under the Tucker Act because the MSPA is not money-mandating and because the Court’s jurisdiction does not extend to contracts implied by law.

II. Standard of Review

In weighing a motion to dismiss for lack of subject-matter jurisdiction, the Court is “obligated to assume all factual allegations to be true and to draw all reasonable inferences in [the] plaintiffs favor.” Henke v. United States, 60 F.3d 795, 797 (Fed.Cir.1995).

It is well-established, however, that subject-matter jurisdiction is “a threshold question that must be resolved ... before proceeding to the merits” of a claim. Steel Co. v. Citizens for a Better Env’t, 523 U.S. 83, 88-89, 118 S.Ct. 1003, 140 L.Ed.2d 210 (1998). “Without jurisdiction the court cannot proceed at all in any cause. Jurisdiction is power to declare the law, and when it ceases to exist, the only function remaining to the court is that of announcing the fact and dismissing the cause.” Ex parte McCardle, 74 U.S. (7 Wall.) 506, 514, 19 L.Ed. 264 (1868). When this court’s jurisdiction is challenged, the plaintiff must demonstrate jurisdiction by a preponderance of the evidence. McNutt v. Gen. Motors Acceptance Corp., 298 U.S. 178, 189, 56 S.Ct. 780, 80 L.Ed. 1135 (1936); Reynolds v. Army & Air Force Exch. Serv., 846 F.2d 746, 748 (Fed.Cir.1988).

III. Discussion

The Tucker Act, 28 U.S.C. § 1491 (2006), grants the United States Court of Federal Claims jurisdiction over monetary actions “against the United States founded either upon the Constitution, or any Act of -Congress or any regulation of an executive department, or upon any express or implied contract with the United States, or for liquidated or unliquidated damages in cases not sounding in tort.” § 1491(a)(1). As such, it is [271]*271an explicit waiver of the sovereign immunity of the United States. United States v. Testan, 424 U.S. 392, 398, 96 S.Ct. 948, 47 L.Ed.2d 114 (1976).

Nevertheless, the Tucker Act is only a jurisdictional statute and does not create any independent substantive rights enforceable against the United States for money damages. See, e.g., United States v. Mitchell,

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Cite This Page — Counsel Stack

Bluebook (online)
103 Fed. Cl. 268, 2012 U.S. Claims LEXIS 28, 2012 WL 184150, Counsel Stack Legal Research, https://law.counselstack.com/opinion/auto-club-insurance-v-united-states-uscfc-2012.