Mspa Claims 1, LLC v. Kingsway Amigo Ins. Co.

361 F. Supp. 3d 1270
CourtDistrict Court, S.D. Florida
DecidedNovember 20, 2018
DocketCASE NO. 1:16-CV-20212-JLK
StatusPublished
Cited by2 cases

This text of 361 F. Supp. 3d 1270 (Mspa Claims 1, LLC v. Kingsway Amigo Ins. 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. Kingsway Amigo Ins. Co., 361 F. Supp. 3d 1270 (S.D. Fla. 2018).

Opinion

JAMES LAWRENCE KING, UNITED STATES DISTRICT JUDGE

THIS CAUSE comes before the Court upon the September 26, 2018 Report & Recommendation of Magistrate Judge Edwin G. Torres (DE 109), recommending that Defendant's Motion for Judgment on the Pleadings ("Motion") (DE 90) be denied.1 After de novo review of the record, the Court concludes that the Motion should be granted.

I. BACKGROUND

This Medicare Secondary Payer Act ("MSP Act"), 42 U.S.C. § 1395y(b), private action originates from conditional payments of medical expenses or supplies that Plaintiff alleges its assignor Florida Health Care Plus ("FHCP") made between "April 29, 2012 (the date of the collision) and July 26, 2012" on behalf of patient F.C. following a motor vehicle accident (DE 36, ¶ 69, 74). Plaintiff alleges that, as assignee of FHCP, it first made a demand for reimbursement to Defendant Kingsway Amigo Insurance Company ("Kingsway") "by letter dated November 23, 2015" (id. ¶ 82). Plaintiff does not allege that it made any demands for reimbursement earlier than this date (see id. ¶ 64-83).

Plaintiff filed its Second Amended Complaint in this case (DE 36) on August 17, 2016. The Court denied in part Kingsway's Motion to Dismiss the Second Amended Complaint (DE 62) on September 29, 2017; and denied Kingsway's Motion to Dismiss for Lack of Jurisdiction (DE 84) on May 17, 2018. Thereafter, on August 7, 2018, Kingsway brought its Motion for Judgment on the Pleadings (DE 90), which is the subject of this Order, in which Kingsway argues that 42 U.S.C. § 1395y(b)(2)(B)(vi), a requirement that Plaintiff did not comply with, applies to this case and so renders Plaintiff's claim stale.

II. DISCUSSION

A. Legal Standard

Federal Rule of Civil Procedure 12(c) allows a party to move for judgment on the pleadings "[a]fter the pleadings are closed but within such time as not to delay the trial." Fed. R. Civ. P. 12(c). Rule 12(c)"provides a means of disposing of cases when ..., a judgment on the merits can be achieved by focusing on the content of competing pleadings." Perez v. Wells Fargo, N.A. , 774 F.3d 1329, 1336 (11th Cir. 2014) (internal quotation marks omitted).

*1272Facts alleged in the complaint must be accepted as true and viewed in the light most favorable to the nonmoving party. Scott v. Taylor , 405 F.3d 1251, 1253 (11th Cir. 2005).

B. Three-Year Limitation Requirement

As Kingsway argues, the Medicare Secondary Payers Act ("MSP Act") plainly and unambiguously requires the government to, as a prerequisite for seeking to recover conditional payments from a primary payer, make a request for payment to the primary payer within three years from the date on which the item or services were furnished to the Medicare enrollee. 42 U.S.C. § 1395y(b)(2)(B)(vi) ;2 MSPA Claims 1, LLC v. Bayfront HMA Me. Ctr., LLC , Case No. 17-cv-21733-GAYLES, 2018 WL 1400465, at *6 (S.D. Fla. Mar. 20, 2018) ("Subparagraph (B)(vi) ... sets forth a timeframe in which the Government must request reimbursement."). The Eleventh Circuit has made clear that a Medicare Advantage Organization ("MAO") standing in the shoes of the government in bringing an MSP Act claim-such as Plaintiff-is bound by the same requirements as Medicare itself would be.3 See, e.g., Humana Med. Plan, Inc. v. W. Heritage Ins. Co. , 832 F.3d 1229, 1236 (11th Cir. 2016) ("MAOs have no cause of action absent a statutory basis."); see also In re Avandia Mktg. Sales Practices & Products Liab. Litig. , 685 F.3d 353, 364 n.18 (3d Cir. 2012) ("Congress clearly intended there to be parity between MAOs and traditional Medicare.").

Plaintiff itself admits in its Second Amended Complaint that it made its first request for payment of Kingsway with a letter dated November 23, 2015 (DE 36, ¶ 74), more than three years after the services were furnished for F.C.'s medical expenses or supplies, which Plaintiff alleges occurred between April 29, 2012 and July 26, 2012 (id. ). Plaintiff makes no argument that it complied with the three-year limitation requirement, or that judgment on the pleadings is inappropriate because of the existence of evidence supporting its compliance with the requirement.4

Plaintiff argues that the three-year limitations requirement, § 1395y(b)(2)(B)(vi), is inapposite to cases like this one, because (1) "the plain meaning of [the provision] grants [a plaintiff] the right to override claims filing requirements required by primary plans, [but does] not impose a limitations period;" (2) the legislative history confirms this; and (3) the Court should grant Chevron deference to *127342 C.F.R. § 411.24(f)(1) (DE 117, at 2, 8). In support of its first point, Plaintiff argues that the permissive word "may" means that the provision is "not mandatory" (DE 117, at 4), but this is nonsensical: the word "may" plainly refers to United States's option as to whether to seek to recover conditional payments at all in a given case, not that "3-year period" actually means "4-year period" or "40-year period." Indeed, as Kingsway has repeatedly noted (see, e.g. , DE 106, at 7), the legislative history Plaintiff cites does nothing to counter this (see DE 117, at 7 (quoting H.R. Rep. No. 105-149, at 1358-59 (1997) (Conf.

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
361 F. Supp. 3d 1270, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mspa-claims-1-llc-v-kingsway-amigo-ins-co-flsd-2018.