Citizens Insurance Co. of America v. United States

102 Fed. Cl. 733, 2011 U.S. Claims LEXIS 2425, 2011 WL 6934813
United States Court of Federal Claims·Decided December 29, 2011·No. No. 11-257 C·Published·Cited by 2 cases

Opinion

OPINION AND ORDER

SWEENEY, Judge.

Plaintiff Citizens Insurance Company of America, a no-fault automobile insurer, alleges that eight motorists it insures were injured in accidents and have been eligible for coverage under the Medicare program since 2005. Plaintiff has paid for medical expenses on behalf of these eight motorists and, citing the Medicare Secondary Payer Act (“MSPA”), now seeks reimbursement. Defendant moves to dismiss the complaint pursuant to Rule 12(b)(1) of the Rules of the United States Court of Federal Claims (“RCFC”), arguing that the MSPA is not a money-mandating statute and that plaintiff has failed to establish jurisdiction in the [737] United States Court of Federal Claims (“Court of Federal Claims”). For the reasons set forth below, defendant’s motion is granted.

I. BACKGROUND

Plaintiff, a Michigan insurance corporation, insured eight motorists who were involved in accidents that occurred prior to December 5, 1980. Compl. ¶¶ 1, 6-15. Plaintiff alleges that coverage afforded under its policies is governed by the requirements of the Michigan No-Fault Automotive Insurance Act (“No-Fault Act”) because these accidents occurred within Michigan. Id. ¶ 15. Plaintiff has paid for medical expenses arising out of each accident on behalf of the eight motorists since 2005.1 Id. ¶¶ 7-14, 16.

According to plaintiff, each motorist elected coordination of medical benefits under his or her insurance policy pursuant to section 3109a of the No-Fault Act. Id. ¶ 17. Because of this election, plaintiff asserts that medical expenses incurred that were related to motor vehicle accidents were, under Michigan law, payable under either the Medicare program or under no-fault insurance coverage, but not under both. Id. Plaintiff alleges that, pursuant to Michigan law,

when an insured’s medical expenses are submitted to a no-fault automobile 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 no-fault insurer’s obligation is to pay the item, and then seek repayment or reimbursement from other coverage or resources.

Id. ¶ 18.

Plaintiff claims that the MSPA governs the priority between the responsibilities of the Centers for Medicare and Medicaid Services (“CMS”), a division of the United States Department of Health and Human Services (“HHS”), and insurers of no-fault automobile insurance policies. Id. ¶ 19. Medicare, plaintiff asserts, is a secondary payer, while no-fault automobile insurance is the primary payer, for accidents that are governed by the MSPA’s provisions. Id. For accidents to which the MSPA’s provisions do not apply, plaintiff alleges that “Medicare is primary for all medical expenses which are covered under the Medicare program, despite the involvement of no-fault automobile insurance.” Id. ¶ 20.

According to plaintiff, the MSPA applies only to motor vehicle accidents that occurred on or after December 5,1980. Id. ¶ 21. For motor vehicle accidents that occurred before that date, plaintiff asserts that the MSPA “does not apply, even for medical expenses incurred after that date,” and Medicare is the primary payer. Id. ¶22. Plaintiff asserts that an implied contract between the CMS and no-fault insurers determines the rights of priority under the MSPA and its implementing regulations. Id. ¶ 24. Contending that Medicare is primarily responsible for payment of the eight motorists’ medical expenses, plaintiff seeks reimbursement from the United States in the amount of $1.5 million for all expenses it has paid on their behalf, plus interest, costs, and fees. Id. ¶ 25.

II. LEGAL STANDARDS

A. Subject Matter Jurisdiction

Whether the court possesses jurisdiction to decide the merits of a case is a threshold matter. See Steel Co. v. Citizens for a Better Env’t, 523 U.S. 83, 94-95, 118 S.Ct. 1003, 140 L.Ed.2d 210 (1998); see also Matthews v. United States, 72 Fed.Cl. 274, 278 (2006) (stating that subject matter jurisdiction is “an inflexible matter that must be considered before proceeding to evaluate the merits of a ease”). “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). The parties or the court sua sponte may challenge the court’s subject matter jurisdiction at any time. Arbaugh v. Y & H Corp., 546 U.S. 500, 506, 126 S.Ct. 1235, 163 L.Ed.2d 1097 (2006).

[738] The ability of the Court of Federal Claims to entertain suits against the United States is limited. “The United States, as sovereign, is immune from suit save as it consents to be sued.” United States v. Sherwood, 312 U.S. 584, 586, 61 S.Ct. 767, 85 L.Ed. 1058 (1941). A waiver of immunity “cannot be implied but must be unequivocally expressed.” United States v. King, 395 U.S. 1, 4, 89 S.Ct. 1501, 23 L.Ed.2d 52 (1969). Thus, unless Congress consents to a cause of action against the United States, “there is no jurisdiction in the Court of Claims more than in any other court to entertain suits against the United States.” Sherwood, 312 U.S. at 587-88, 61 S.Ct. 767.

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Citizens Insurance Co. of America v. United States, 102 Fed. Cl. 733, 2011 U.S. Claims LEXIS 2425, 2011 WL 6934813 (uscfc 2011).

102 Fed. Cl. 733 (Citizens Insurance Co. of America v. United States) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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