MSPA Claims 1, LLC v. Covington Specialty Insurance Co.

212 F. Supp. 3d 1250, 2016 U.S. Dist. LEXIS 140164, 2016 WL 5719805
CourtDistrict Court, S.D. Florida
DecidedSeptember 30, 2016
DocketCASE NO. 16-20338-CIV-LENARD/GOODMAN
StatusPublished
Cited by10 cases

This text of 212 F. Supp. 3d 1250 (MSPA Claims 1, LLC v. Covington Specialty Insurance Co.) 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
MSPA Claims 1, LLC v. Covington Specialty Insurance Co., 212 F. Supp. 3d 1250, 2016 U.S. Dist. LEXIS 140164, 2016 WL 5719805 (S.D. Fla. 2016).

Opinion

ORDER GRANTING MOTION TO DISMISS AMENDED COMPLAINT AND CLASS ACTION ALLEGATIONS (D.E. 25)

JOAN A. LENARD, UNITED STATES DISTRICT JUDGE

THIS CAUSE is before the Court on Defendant Covington Specialty Insurance Company’s Motion to Dismiss Amended Complaint and Class Action Allegations, (“Motion,” D.E. 25), filed March 23, 2016. Plaintiff MSPA Claims 1, LLC filed a Response on April 15, 2016, (“Response,” D.E. 31), to which Defendant filed a Reply on April 21, 2016, (“Reply,” D.E. 32).

Also before the Court is Plaintiffs Request for Judicial Notice, (D.E. 39), filed June 16, 2016. Defendant filed a Response to Plaintiffs Request on June 30, 2016, (D.E. 41), to which Plaintiff filed a Reply on July 11, 2016, (D.E. 42). Upon review of the Motions, Responses, Replies and the record, the Court finds as follows.

I. Background

This is an action under the Medicare Secondary Payer Act (“MSP Act”), 42 U.S.C. § 1395y(b)(3)(A), alleging that Defendant failed to reimburse a Medicare Advantage Organization (“MAO”) for medical payments made on behalf of an enroll-ee, F.C.,1 who was injured as a result of an accident that occurred on property insured by Defendant. (See Am. Compl., D.E. 10 ¶¶ 10-37, 77-88.)

Florida Healthcare Plus (“FHCP”) was a Health Maintenance Organization (“HMO”) that contracted with the Centers for Medicare and Medicaid Services (“CMS”) to provide Medicare benefits to eligible members enrolled in FHCP’s Medicare Advantage health plan under Part C of the Medicare Act. (Id. ¶ 6.) Plan members are referred to as “enrollees,” and FHCP served the needs of its enroll-ees through its Medicare and managed care programs, delivered through its network of physicians and health care professionals. (Id. ¶ 6.) FHCP was a “secondary payer” pursuant to the MSP Act. (Id. ¶ 8.) [1255]*1255On December 10, 2014, FHCP went into receivership. (Id.)

According to the Complaint, F.C. was a member of a Medicare Advantage Plan managed by FHCP at the time of the accident. (Id. ¶ 15.) The Plan is considered a “secondary plan” in connection with medical expense coverage for the at-issue accident, and provides FHCP with reimbursement, recovery, and subrogation rights from a “primary plan.” (Id. ¶ 17.) FHCP paid for F.C.’s medical expenses, totaling $15,825.43, pursuant to its contract with CMS. (Id. ¶ 19.) The Amended Complaint alleges that Defendant was legally responsible for primary payment of F.C.’s injuries through its no fault Med-Pay insurance policy. (See id. ¶¶ 13, 14, 17.) “As the issuer of the primary plan, Defendant was required to pay for the medical services provided to Enrollee, or to reimburse FHCP for all payments it made on behalf of Enrollee to satisfy such medical bills; however, Defendant failed to do either and continues to do so.” (Id. ¶ 26.) Plaintiff alleges that FHCP assigned all of its sub-rogation claims, recovery, and reimbursement rights to Plaintiff; as such, Plaintiff asserts standing to sue Defendant for the medical claims, bills, and expenses FHCP provided on behalf of F.C. (Id. ¶¶ 52, 55.)

On March 9, 2016, Plaintiff filed its Amended Class Action Complaint for Damages. (D.E. 23.) Count I alleges a violation of the MSP Act, 42 U.S.C. § 1395y(b)(3)(A), (id. ¶¶ 77-88); Count II alleges breach of contract for failure to pay Med-Pay benefits, (id. ¶¶ 89-97); Count III is for conventional subrogation, (id. ¶¶ 98-104); Count IV is for equitable sub-rogation, (id. ¶¶ 105-111) and Count V is for conventional subrogation arising from third-party beneficiary rights, (id. ¶¶ 112-118). The Amended Complaint also contains class allegations, purporting to bring suit on behalf of a class of MAOs similarly situated to Plaintiff. (Id. ¶¶ 56-76.)

On March 23, 2016, Defendant filed the instant Motion to Dismiss. (D.E. 25.) It argues that (1) Plaintiff lacks standing to sue Defendant as a purported assignee of FHCP; and, (2) even if Plaintiff had standing to sue, the claims fail to state a claim upon which relief can be granted. (Id. at 1-2.) Defendant also moves to strike the class allegations. (Id. at 17.) Because the Court agrees that Plaintiff lacks standing, it will confine its discussion to that issue.

II. Legal Standard

To the extent Defendant challenges Plaintiffs standing to pursue FHCP’s claims, Federal Rule of Civil Procedure 12(b)(1) applies. Stalley ex rel. United States v. Orlando Reg’l Healthcare Sys., Inc., 524 F.3d 1229, 1232 (11th Cir. 2008). “ ‘Because standing is jurisdictional, a dismissal for lack of standing has the same effect as a dismissal for lack of subject matter jurisdiction under Fed. R. Civ. P. 12(b)(1).” Id. (quoting Cone Corp. v. Fla. Dep’t of Transp., 921 F.2d 1190, 1203 n. 42 (11th Cir.1991). “A defendant can move to dismiss a complaint under Rule 12(b)(1) for lack of subject matter jurisdiction by either facial or factual attack.” Id. (citing McElmurray v. Consol. Gov’t of Augusta-Richmond Cnty., 501 F.3d 1244, 1251 (11th Cir.2007)). “ ‘A facial attack on the complaint requires the court merely to look and see if the plaintiff has sufficiently alleged a basis of subject matter jurisdiction, and the allegations in his complaint are taken as true for the purposes of the motion.’ ” Id. at 1232-33 (citing McElmurray, 501 F.3d at 1251). “Factual attacks, on the other hand, challenge the existence of subject matter jurisdiction in fact, irrespective of the pleadings, and matters outside the pleadings, such as testimony and affidavits are considered.” McElmurray, 501 F.3d at 1251 (citations and internal quotation marks omitted). “A dismissal for lack of subject matter jurisdiction is not a [1256]*1256judgment on the merits and is entered without prejudice.” Stalley, 524 F.3d at 1232 (citing Crotwell v. Hockman-Lewis Ltd., 734 F.2d 767, 769 (11th Cir.1984)).

III. Discussion

Defendant argues that Plaintiff lacks standing to sue Defendant because Plaintiff suffered no injury, and the purported assignments were either invalid, ineffective, or have expired. (Mot. at 5.) Plaintiff argues that FHCP assigned its rights of reimbursement to La Ley Recovery Systems, Inc., and that, in turn, La Ley assigned its rights to Plaintiff. (See Resp. at 2-8.)

The Eleventh Circuit recently held that the private cause of action under the MSP Act, 42 U.S.C. § 1395y(b)(3)(A), permits a MAO—like FHCP—to sue a primary payer—like Defendant—that refuses to reimburse the MAO for a secondary payment. Humana Med. Plan, Inc. v. W. Heritage Ins. Co., 832 F.3d 1229, 1231, 1237-38 (11th Cir. 2016).

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

Related

Mspa Claims 1, LLC v. First Acceptance Ins. Co.
380 F. Supp. 3d 1235 (M.D. Florida, 2019)
MSPA Claims 1, LLC v. Tenet Florida, Inc.
918 F.3d 1312 (Eleventh Circuit, 2019)
MSPA Claims 1, LLC v. Scottsdale Ins. Co.
352 F. Supp. 3d 1234 (S.D. Florida, 2018)
MSPA Claims 1, LLC v. Infinity Auto Ins. Co.
344 F. Supp. 3d 1377 (S.D. Florida, 2018)
MSPA Claims 1, LLC v. Liberty Mut. Fire Ins. Co.
322 F. Supp. 3d 1273 (S.D. Florida, 2018)
MSP Recovery, LLC v. Allstate Insurance Co.
276 F. Supp. 3d 1311 (S.D. Florida, 2017)

Cite This Page — Counsel Stack

Bluebook (online)
212 F. Supp. 3d 1250, 2016 U.S. Dist. LEXIS 140164, 2016 WL 5719805, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mspa-claims-1-llc-v-covington-specialty-insurance-co-flsd-2016.