MSP Recovery Claims Series 44, LLC v. United Services Automobile Association (USAA)

CourtDistrict Court, S.D. Florida
DecidedMay 17, 2022
Docket1:20-cv-21530
StatusUnknown

This text of MSP Recovery Claims Series 44, LLC v. United Services Automobile Association (USAA) (MSP Recovery Claims Series 44, LLC v. United Services Automobile Association (USAA)) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
MSP Recovery Claims Series 44, LLC v. United Services Automobile Association (USAA), (S.D. Fla. 2022).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA

Case No.: 20-cv-21530-GAYLES/OTAZO-REYES

MSP RECOVERY CLAIMS, SERIES LLC, MSP RECOVERY CLAIMS SERIES 44, LLC, MSPA CLAIMS 1, LLC, and SERIES PMPI, a designated series of MAO-MSO RECOVERY II, LLC,

Plaintiffs, v.

UNITED SERVICES AUTOMOBILE ASSOCIATION, USAA CASUALTY INSURANCE COMPANY, and USAA GENERAL INDEMNITY COMPANY,

Defendants. /

ORDER

THIS CAUSE comes before the Court upon Defendants United Services Automobile Association, USAA Casualty Insurance Company, and USAA General Indemnity Company’s Motion to Dismiss the Second Amended Complaint (the “Motion”) [ECF No. 93]. The Court has reviewed the Motion and the record and is otherwise fully advised. For the reasons discussed below, the Motion is granted in part. BACKGROUND Plaintiffs MSP Recovery Claims, Series LLC (“MSPRC”), MSP Recovery Claims Series 44, LLC (“Series 44”), MSPA Claims 1, LLC (“MSPAC”) and Series PMPI, a designated series of MAO-MSO Recovery II, LLC (“MAO-MSO”) (collectively “Plaintiffs”) bring this putative class action against Defendants United Services Automobile Association (“USAA”), USAA Casualty Insurance Company (“USAA Casualty”), and USAA General Indemnity Company (“USAA General”) (collectively “Defendants”), seeking reimbursement for conditional payments made on behalf of Medicare Part C enrollees in accordance with the Medicare Secondary Payer Act (“MSP Act”). I. The MSP ACT In 1980, in an effort to reduce health care costs to the federal government, Congress enacted

the MSP Act. See Glover v. Liggett Grp., Inc., 459 F.3d 1304, 1306 (11th Cir. 2006). The MSP Act made “Medicare the secondary payer for medical services provided to Medicare beneficiaries whenever payment is available from another primary payer.” Id. Subparagraph (2)(B) of the MSP Act permits Medicare to “make conditional payments for covered services, even when another source may be obligated to pay, if that other source is not expected to pay promptly.” Id. (internal quotation omitted). However, “[s]uch payment is conditioned on Medicare’s right to reimbursement if a primary plan later pays or is found to be responsible for payment of the item or service.” Id. The MSP Act’s conditional payment provision permits the United States to bring an action for double damages against a primary insurer or an entity that received payment from a primary

insurer when that primary insurer or entity fails to reimburse Medicare for conditional payments made on behalf of an enrollee. 42 U.S.C. § 1395y(b)(2)(B)(iii). In addition, the MSP Act provides for “a private cause of action for damages (which shall be in an amount double the amount otherwise provided) in the case of a primary plan which fails to provide for primary payment (or appropriate reimbursement) in accordance with paragraphs (1) and (2)(A).” § 1395y(b)(3)(A). In 1997, Congress created the Medicare Advantage program wherein private insurance companies, operating as Medicare Advantage Organizations (“MAOs”), contract with the Centers for Medicare and Medicaid Services to administer Medicare benefits to individuals enrolled in a Medicare Advantage program under Medicare Part C. See Humana Med. Plan, Inc. v. W. Heritage

Ins., 832 F.3d 1229, 1234 (2016). Part C designates MAOs as secondary payers, like Medicare. 42 U.S.C. § 1395w-22(a)(4). “[A]n MAO may avail itself of the MSP private cause of action when a primary plan fails to make primary payment or to reimburse the MAO’s secondary payment.” Humana, 832 F.3d at 1238. II. The Assignments

Plaintiffs and their related entities “are collection agencies that specialize in recovering funds on behalf of various actors in the Medicare Advantage system.” MSP Recovery Claims, Series LLC v. Ace American Ins. Co., 974 F.3d 1305, 1308 (11th Cir. 2020). Plaintiffs allege that they have standing to bring MSP Claims against Defendants based on assignments from AvMed, Inc. “(AvMed”), ConnectiCare, Inc. (“CONC”), Interamerican Medical Center (“IMC”), Preferred Medical Plan, Inc. (“PMPI”), and Health First Health Plan, Inc. (“HFHP”) (collectively the “Assignors”). [ECF No. 88].1 III. Plaintiffs’ Prior Actions Against Defendants Plaintiffs and their related entities have filed hundreds of actions against insurance companies. Included in those many actions are three actions filed by some of the Plaintiffs in this

action against some of the Defendants in this action. On March 13, 2017, MSPAC, MAO-MSO, and MSP Recovery, LLC2 filed an action against USAA Casualty alleging claims under 42 U.S.C. § 1395y(b)(3)(A) and 42 C.F.R. § 411.24(e). See MAO-MSO Recovery II, LLC, et al. v. USAA Cas. Ins. Co., No. 17-cv-20946-JAL (S.D. Fla.) (“Prior Action 1”). On April 4, 2018, after three

1 As detailed in Appendix 2 to the Second Amended Complaint, IMC assigned its rights under the MSP Act to MSP Recovery, LLC on December 16, 2014. Appendix 2 ¶ 18. On February 20, 2015, MSP Recovery, LLC assigned the IMC rights to MSPAC. Id. ¶ 19. AvMed assigned its rights under the MSP Act to Series 17-03-615, a designated series of MSPRC, on June 26, 2019. Id. CONC assigned its rights under the MSP Act to MSP Recovery, LLC on March 20, 2018. Id. MSP Recovery, LLC then assigned the CONC rights to Series 15-09-157, a designated series of MSPRC on April 4, 2018. Id. PMPI assigned its rights under the MSP Act to MSP Recovery, LLC on May 3, 2016. Id. MSP Recovery, LLC then assigned the PMPI rights to Series PMPI, a designated series of MAO-MSO on August 8, 2016. Id. HFHP assigned its rights under the MSP Act to MSP Recovery, LLC on April 28, 2016. Id. MSP Recovery, LLC then assigned the HFHP rights to Series 16-05-456, a designated series of MSPRC on June 12, 2017. Id. On October 22, 2020, Series 16-05-456 assigned the HFHP rights to Series 44-20-456, a designated series of Series 44. Id. attempts at pleading claims against USAA Casualty, including a second amended complaint which replaced MSP Recovery, LLC with MSPRC, the plaintiffs voluntarily dismissed Prior Action 1. Id. On April 5, 2017, MSPAC, MAO-MSO, and MSP Recovery, LLC filed another action against USAA Casualty alleging a claim under 42 U.S.C. § 1395y(b)(3)(A). See MAO-MSO Recovery II,

LLC, et al. v. USAA Cas. Ins. Co., No. 17-cv-21289-KMW (S.D. Fla.) (“Prior Action 2”). After multiple attempts to plead their claims, the plaintiffs voluntarily dismissed Prior Action 2. Finally, on August 10, 2017, MSPRC filed an action against USAA in the Eleventh Judicial Circuit in and for Miami-Dade County, Florida (“Prior Action 3”). USAA removed Prior Action 3 to this Court. See MSP Recovery Claims, Series LLC v. United Services Auto Ass’n, No. 18-cv-21626-CMA. On July 2, 2018, MSPRC filed a third amended complaint in Prior Action 3, dropping USAA as a defendant and replacing it with USAA General. Id. On October 19, 2018, the Court dismissed Prior Action 3 against USAA General. Id. IV. The Current Action A. The Complaint

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