MSP RECOVERY CLAIMS, SERIES LLC v. Nationwide Mutual Insurance Company

CourtDistrict Court, S.D. Florida
DecidedFebruary 2, 2021
Docket1:20-cv-21573
StatusUnknown

This text of MSP RECOVERY CLAIMS, SERIES LLC v. Nationwide Mutual Insurance Company (MSP RECOVERY CLAIMS, SERIES LLC v. Nationwide Mutual Insurance Company) 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 LLC v. Nationwide Mutual Insurance Company, (S.D. Fla. 2021).

Opinion

United States District Court for the Southern District of Florida

MSP Recovery Claims Series, LLC, ) and others, Plaintiffs, ) ) v. ) Civil Action No. 20-21573-Civ-Scola ) Nationwide Mutual Insurance ) Company and others, Defendants. )

Order Granting Joint Motion to Dismiss Plaintiffs MSP Recovery Claims, Series LLC; MSPA Claims 1, LLC; and Series PMPI, a designated series of MAO-MSO Recovery II, LLC seek to recover, through this putative class action, reimbursement from twenty-five Defendant insurers (the “Insurance Companies”) for amounts the Plaintiffs claim to be owed as a result of Medicare payments the Plaintiffs’ assignors, and other Medicare Advantage Organizations, made to or on behalf of the Insurance Companies’ insureds. (Compl., ECF No. 1.) The Plaintiffs claim entitlement to these funds as provided for under the Medicare Secondary Payer Act (the “MSPA”). The Insurance Companies, jointly, seek dismissal of the complaint because the Plaintiffs have failed to establish the Court’s personal jurisdiction over the Insurance Companies or, if the Court finds it does have jurisdiction, because the Plaintiffs have failed to state a claim to relief that is plausible on its face. (Defs.’ Mot., ECF No. 23.) The Insurance Companies, alternatively, maintain this case should be transferred to the United District Court for the Southern District of Ohio. (Id. at 26–23.) The Plaintiffs counter the Court does have jurisdiction over the Insurance Companies, that venue is proper in this Court, and that they have stated a claim for relief under the MSPA. (Pls.’ Resp., ECF No. 31.) The Insurance Companies have timely replied. (Defs.’ Reply, ECF No. 34.) After careful review, the Court finds the Plaintiffs have failed to carry their burden of establishing the Court’s personal jurisdiction over the Insurance Companies and, therefore, grants their motion (ECF No. 23) on that basis, dismissing the complaint, without prejudice. 1. Background The Insurance Companies are all auto or other liability insurers that provide either “no-fault” or “med-pay” insurance to their customers, including Medicare beneficiaries enrolled under Part C of the Medicare Act (“Enrollees”). (Compl., ¶ 2.) The Plaintiffs say that under the Insurance Companies’ contractual obligations with their insureds, and under state law, the Insurance Companies must provide coverage for their insureds’ accident-related medical expenses on a “no-fault” basis. (Id.) The Insurance Companies are considered to have primary responsibility, under the MSPA, regarding Enrollee medical expenses occasioned by car or other accidents. (Id.) That is, Medicare’s responsibility to pay for the accident-related medical expenses of the Enrollees is secondary to the Insurance Companies’ responsibility. (Id.) Medicare and Medicare Advantage Organizations, however, routinely pay these medical expenses, albeit on a conditional basis. (Pls.’ Resp. at 2.) These payments are typically made “as an accommodation” for the Enrollees, subject to being recouped from the primary payer, so long as the payment is for a service that was, or should have been, covered by a primary insurer. (Id. at 2–3.) The Plaintiffs complain, generally, “that primary payers like Defendants” “rarely honor their obligations and, instead, take steps to ensure the burden for those accident-related medical expenses is borne by Medicare and MA Plans.” (Id. ¶ 6.) Various Medicare Advantage Plans that provide Medicare benefits have assigned their rights to recover these payments, under the MSPA, to the Plaintiffs. (Id. ¶ 3.) The Plaintiffs say they use a proprietary system to process health-care claims data from various sources in order to track down which primary payers have failed to honor their reimbursement obligations under the MSPA. (Id. ¶ 9.) Sixteen of the Insurance Companies have principal places of business in Ohio; four in Iowa; and one each in Texas, Pennsylvania, Arizona, New Mexico, and Michigan. (Id. ¶¶ 17–41.) The Plaintiffs say the Insurance Companies “have systematically and uniformly failed to pay or reimburse conditional payments by Plaintiffs’ assignors and Class Members on behalf of Enrollees for accident- related medical expenses.” (Id. ¶ 51.) The Plaintiffs have provided a spreadsheet that they say identifies “numerous instances where Defendants admitted . . . they were obligated . . . to provide primary payment on behalf Enrollees.” (Id. ¶ 63; Ex. A., ECF No. 1-1.) The Plaintiffs also describe this list as identifying “instances where Defendants have failed to pay and/or reimburse conditional payments made Plaintiffs’ assignors for accident-related expenses.” (Id. ¶ 66.) The Plaintiffs describe with more detail three “Exemplar No-Fault Claims” and two “Exemplar Settlement Claims.” The three exemplar no-fault claims involve Enrollees of MA Plans issued and administered by AvMed, Inc. (Id. ¶¶ 76, 85, 94.) In the first exemplar, Enrollee, A.H. was “injured in an accident” on February 3, 2019. (Id. ¶ 77.) A.H.’s accident-related medical costs and expenses were purportedly covered under no-fault policies issued by Defendants Nationwide Mutual Insurance Company and Nationwide Insurance Company of America. (Id. ¶ 78.) A.H. received medical services on February 3 and 4, 2019. (Id. ¶ 80.) AvMed paid $3,451.81 for these services. (Id.) The Plaintiffs say that Defendants Nationwide Mutual Insurance Company and Nationwide Insurance Company of America “admitted their primary payer status related to payment and/or reimbursement of A.H.’s accident-related medical expenses” and yet, nonetheless, failed to reimburse AvMed. (Id. ¶¶ 81–2.) The second and third no-fault exemplars are nearly identical to the first. These exemplars involve two other Enrollees, P.J. and H.R., respectively. They too were each “injured in an accident” and required medical care: P.J. in 2016 and H.R. in 2018. (Id. ¶¶ 86, 89, 95, 98.) Both Enrollees’ medical expenses were purportedly covered under a no-fault policy issued by Defendant Nationwide Mutual Insurance Company. (Id. ¶¶ 87, 96.) AvMed paid $2,260.73 to P.J.’s medical providers and $13,759.10 for H.R.’s. (Compl. ¶¶ 89, 98.) As in the first exemplar, the Plaintiffs maintain Defendant Nationwide Insurance Company “admitted its primary payer status related to payment and/or reimbursement of [the Enrollees’] accident-related medical expenses” and yet, nonetheless, failed to reimburse AvMed. (Id. ¶¶ 91–2, 100–01.) The two exemplar settlement claims also both involve AvMed and Nationwide Mutual Insurance Company. In those cases, two other Enrollees, K.M. and L.B., were both, like in the no-fault exemplars, each “injured in an accident”: K.M. in 2019 and L.B. in 2015. (Id. ¶¶ 104, 114.) In each case, the alleged tortfeasor responsible for the accident was insured by Nationwide Mutual Insurance Company. (Id. ¶¶ 105, 115.) AvMed paid $450.86 to K.M.’s medical providers and $328.84 to L.B.’s. (Id. ¶¶ 107, 117.) Nationwide ultimately settled with both K.M. and L.B., on behalf of their respective tortfeasors, making payments to both. (Id. ¶¶ 108, 118.) As in the three no-fault exemplars, the Plaintiffs maintain Defendant Nationwide Insurance Company “admitted its primary payer status related to payment and/or reimbursement of [the Enrollees’] accident-related medical expenses” and yet, nonetheless, failed to reimburse AvMed. (Id. ¶¶ 109–10, 119–20.) 2. Legal Standard Federal Rule of Civil Procedure 12(b)(2) governs motions to dismiss for lack of personal jurisdiction. “A plaintiff seeking the exercise of personal jurisdiction over a nonresident defendant bears the initial burden of alleging in the complaint sufficient facts to make out a prima facie case of jurisdiction.” United Techs. Corp. v. Mazer, 556 F.3d 1260, 1274 (11th Cir.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Seiferth v. Helicopteros Atuneros, Inc.
472 F.3d 266 (Fifth Circuit, 2006)
Sculptchair, Inc. v. Century Arts, Ltd.
94 F.3d 623 (Eleventh Circuit, 1996)
Stubbs v. Wyndham Nassau Resort & Crystal Palace Casino
447 F.3d 1357 (Eleventh Circuit, 2006)
Michael Snow v. Directv, Inc.
450 F.3d 1314 (Eleventh Circuit, 2006)
United Technologies Corp. v. Mazer
556 F.3d 1260 (Eleventh Circuit, 2009)
VERIZON TRADEMARK SERVICES, LLC v. Producers, Inc.
810 F. Supp. 2d 1321 (M.D. Florida, 2011)
Louis Vuitton Malletier, S.A. v. Joseph Mosseri
736 F.3d 1339 (Eleventh Circuit, 2013)
Daimler AG v. Bauman
134 S. Ct. 746 (Supreme Court, 2014)
William B. Newton v. Duke Energy Florida, LLC
895 F.3d 1270 (Eleventh Circuit, 2018)
BNSF Ry. Co. v. Tyrrell
581 U.S. 402 (Supreme Court, 2017)

Cite This Page — Counsel Stack

Bluebook (online)
MSP RECOVERY CLAIMS, SERIES LLC v. Nationwide Mutual Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/msp-recovery-claims-series-llc-v-nationwide-mutual-insurance-company-flsd-2021.