MSP Recovery Claims, Series LLC v. QBE Holdings, Inc.

965 F.3d 1210
CourtCourt of Appeals for the Eleventh Circuit
DecidedJuly 15, 2020
Docket19-11759
StatusPublished
Cited by25 cases

This text of 965 F.3d 1210 (MSP Recovery Claims, Series LLC v. QBE Holdings, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit 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. QBE Holdings, Inc., 965 F.3d 1210 (11th Cir. 2020).

Opinion

Case: 19-11759 Date Filed: 07/15/2020 Page: 1 of 21

[PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT ________________________

No. 19-11759 ________________________

D.C. Docket No. 6:18-cv-01458-GAP-GJK

MSP RECOVERY CLAIMS, SERIES LLC, SERIES 16-05-456, a designated series of MSP Recovery Claims, Series LLC,

Plaintiffs-Appellants,

versus

QBE HOLDINGS, INC., QBE INSURANCE CORPORATION, QBE REINSURANCE CORPORATION,

Defendants-Appellees.

________________________

Appeal from the United States District Court for the Middle District of Florida ________________________

(July 15, 2020) Case: 19-11759 Date Filed: 07/15/2020 Page: 2 of 21

Before MARTIN and NEWSOM, Circuit Judges, and WATKINS, * District Judge.

MARTIN, Circuit Judge:

The District Court dismissed for lack of standing this action for damages

under the Medicare Secondary Payer Act (the “Act”), 42 U.S.C. § 1395y(b).

Following careful review, and with the benefit of oral argument, we affirm the

dismissal but remand to the District Court with instructions to dismiss the

complaint without prejudice.

I. BACKGROUND

This case involves a complicated statute as well as a large number of

similarly named parties, non-parties, and documents. We therefore must begin our

opinion with an overview of these moving parts, as well as discussion of the

procedural history prior to this appeal.

A. THE MEDICARE SECONDARY PAYER ACT

Medicare is a federal program that provides insurance to those over the age

of 65. See MSPA Claims 1, LLC v. Kingsway Amigo Ins. Co., 950 F.3d 764, 767

(11th Cir. 2020). In many circumstances, a beneficiary’s healthcare costs are paid

entirely by Medicare. See id. But that is not always the case. Sometimes a third

party has an obligation to pay for a beneficiary’s healthcare costs, such as when a

* Honorable W. Keith Watkins, United States District Judge for the Middle District of Alabama, sitting by designation.

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person enrolled in Medicare “is injured in an automobile accident caused by

another driver,” id., or if the enrollee “carrie[s] other insurance that cover[s] the

same costs” as Medicare, MSP Recovery, LLC v. Allstate Ins. Co., 835 F.3d 1351,

1354–55 (11th Cir. 2016).

Before Congress enacted the Medicare Secondary Payer Act in 1980,

“Medicare was deemed the ‘primary’ payer in these instances—meaning that it

paid first—and private insurers were ‘secondary’ payers—meaning that they

covered any remainder.” Kingsway, 950 F.3d at 767. The Act was intended “to

reduce the costs of Medicare” by transforming Medicare from a primary payer into

a secondary payer. See Allstate, 835 F.3d at 1354–55. Under the Act, Medicare

does not pay “for items or services for which a primary plan has paid or can

reasonably be expected to pay.” Humana Med. Plan, Inc. v. W. Heritage Ins. Co.,

832 F.3d 1229, 1234 (11th Cir. 2016). Instead, the burden to make primary

payment now falls on “a group health plan, worker’s compensation plan or law,

automobile or other liability insurance policy or plan, no-fault insurance, or self-

insured plan that has made or can reasonably be expected to make payment for an

item or service.” Id. at 1233 n.1. In 1997, Congress enacted the Medicare

Advantage program—also known as Medicare Part C—which allows a private

insurance company operating as a so-called “Medicare Advantage Organization”

(“MAO”) to “administer[] the provision of Medicare benefits pursuant to a contract

3 Case: 19-11759 Date Filed: 07/15/2020 Page: 4 of 21

with” the Centers for Medicare & Medicaid Services. Id. at 1235. In other words,

“[t]he legislation creating Medicare Part C made MAOs—like Medicare itself—

secondary payers.” Kingsway, 950 F.3d at 768.

If a primary payer does not make a required payment under the Act, “the

Secretary of Health & Human Services may make a payment conditioned on

reimbursement.” Humana, 832 F.3d at 1234. “If the Secretary makes a

conditional payment, the primary plan must reimburse the Secretary.” Id. This

reimbursement may be secured in one of two ways. The United States may bring

suit against the primary payer. 42 U.S.C. § 1395y(b)(2)(B)(iii). Alternatively, “a

Medicare beneficiary whose primary plan has not paid Medicare or the

beneficiary’s healthcare provider” may assert a private cause of action for twice the

damages otherwise available. Humana, 832 F.3d at 1234 (citing 42 U.S.C.

§ 1395y(b)(3)(A)). Our Court has ruled that MAOs may sue under this private

right of action “to recover from primary plans that should pay, but don’t.”

Kingsway, 950 F.3d at 768.

B. PARTIES AND NON-PARTIES

Here, the Plaintiffs are MSP Recovery Claims, Series LLC (“MSP Series”),

a Delaware limited liability company with its principal place of business in

Florida; and Series 16-05-456, a “series” of MSP Series established under

Delaware law, see Del. Code Ann. tit. 6, § 18-215(a), with its principal place of

4 Case: 19-11759 Date Filed: 07/15/2020 Page: 5 of 21

business in Florida.1 MSP Recovery, LLC (“MSP Recovery”) is a Florida limited

liability company associated with but distinct from MSP Series and Series 16-05-

456. MSP Recovery is not a party to this action.

The Plaintiffs here purport to bring suit pursuant to an assignment by Health

First Health Plans, Inc. (“HFHP”), an MAO. Health First Administrative Plans,

Inc. (“HFAP”) is a separate company that provides all administrative functions on

HFHP’s behalf.

The Defendants here are QBE Holdings, Inc., QBE Insurance Corp., and

QBE Reinsurance Corp. (collectively, “QBE”). QBE is a no-fault insurer that

qualifies as a primary payer under the Act.

C. RELEVANT CONTRACTS

1. Recovery Agreement

On April 28, 2016, HFAP assigned to MSP Recovery “all rights to recover

conditional payments” under the Act “on behalf of its [e]nrollees.” This document

is called the “Recovery Agreement.” The Recovery Agreement applies to “MSP

Recovery, and any of its successors and assigns.” According to the Plaintiffs, the

intention behind the Recovery Agreement was to permit MSP Recovery to pursue

1 The District Court found that Series 16-05-456 was not a proper plaintiff because it is not “a legal entity that may bring suit in its own name.” R. Doc. 50 at 1 n.1. We agree with the Plaintiffs that Series 16-05-456 is due to be reinstated as a party. Contrary to the District Court’s finding, Series 16-05-456, as a series of MSP Series under Delaware law, has the power to “sue and be sued.” Del. Code Ann. tit. 6, § 18-215(b)(1); see Br. of Appellants at 27 n.4.

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