MSPA Claims 1, LLC v. Liberty Mut. Fire Ins. Co.

322 F. Supp. 3d 1273
CourtDistrict Court, S.D. Florida
DecidedJuly 31, 2018
DocketCase No. 17-22539-CIV-WILLIAMS
StatusPublished
Cited by10 cases

This text of 322 F. Supp. 3d 1273 (MSPA Claims 1, LLC v. Liberty Mut. Fire 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. Liberty Mut. Fire Ins. Co., 322 F. Supp. 3d 1273 (S.D. Fla. 2018).

Opinion

KATHLEEN M. WILLIAMS, UNITED STATES DISTRICT JUDGE

THIS MATTER is before the Court on Defendant Liberty Mutual Fire Insurance Company's ("Defendant") motion to dismiss the Plaintiffs' ("Plaintiffs") third amended complaint for lack of subject matter jurisdiction and failure to state a claim (DE 51), to which Plaintiffs filed a response in opposition (DE 58), and to which Defendant filed a reply (DE 60). For the reasons set forth below, Defendant's motion to dismiss (DE 51) is GRANTED WITH PREJUDICE1 and this case is DISMISSED for lack of subject matter jurisdiction.

I. BACKGROUND

This lawsuit arises under the Medicare Secondary Payer ("MSP") provisions of the Medicare Act, 42 U.S.C. § 1395y et seq. Plaintiffs' class action complaint against Defendant is one of numerous similar actions filed by Plaintiffs in courts *1276across the country.2 Plaintiffs are a collection of entities "whose business model involves obtaining assignments from Medicare Advantage Organizations [ ("MAOs") ], first-tier entities, and downstream entities to recover reimbursement for payments made for the medical expenses of Medicare beneficiaries that should have been made by a private insurer pursuant to the Medicare Secondary Payer Act (MSPA)." Auto-Owners , 2018 WL 1953861, at *1 (citing 42 U.S.C. § 1395y(b) ). Plaintiffs filed this class action as the assignee of three separate entities-Florida Healthcare Plus ("FHCP"), Health First Administrative Plans, Inc. ("HFAP") and Interamerican Medical Center Group, LLC ("IMCG")-to seek reimbursement from Defendant pursuant to the MSPA. Thus, as the Court in Auto-Owners noted, the threshold issue this Court must consider is whether these entities "ha[ve] standing under the private cause of action in the MSPA, § 1395y(b)(3)(A)." Auto-Owners , 2018 WL 1953861, at *1.

Defendant argues, among other things, that Plaintiffs lack standing to bring this case because (a) "the Complaint does not allege that any of the putative assignors are (1) a Medicare beneficiary; (2) an MAO; or a (3) direct healthcare provider to the Medicare beneficiary;" (b) the "original plaintiff, MSPA Claims I, LLC ("MSPA [Claims]"), lacked standing when the lawsuit was filed ... [and] cannot amend to add new plaintiffs;" and (c) "the Complaint does not support that Plaintiffs have standing under the putative assignments because, among other reasons, the agreements are not assignments." (DE 51 at 2). Defendant also presents several other arguments as to why Plaintiffs have failed to state a claim under Federal Rule of Civil Procedure 12(b)(6) but, because this case must be dismissed for lack of subject matter jurisdiction, we need not address the merits of Defendant's other arguments.

As the alleged assignee of FHCP, HFAP, and IMCG (the "Assignors"), Plaintiffs bring three representative claims. (DE 49 at 5-7). B.T., M.H., and ST. were Medicare beneficiaries (the "Beneficiaries") who were enrolled in Medicare Advantage plans managed by FHCP, FHAP, and IMCG, respectively. Id. Plaintiffs further allege that the Assignors paid for the Beneficiaries' respective medical expenses and that Defendant, as a primary payer, should have paid for the expenses or reimbursed the Assignors for the expenses, but failed to do so. Id. Plaintiffs allege that the Assignors each assigned their rights to recover conditional payments made on behalf of Medicare beneficiaries to Plaintiffs. Id.

*1277The recovery agreements and assignment documents filed with Plaintiffs' third amended complaint-pursuant to which the Assignors purportedly assigned their claims to Plaintiffs-contain boilerplate language identical to the documents filed by Plaintiffs in other suits describing each of the Assignors broadly as a "Health Maintenance Organization, Maintenance Service Organization, Independent Practice Association, Medical Center, and/or other health care organization and/or provider ...." (DE 49-H; DE 49-L; DE 49-N). These documents are similar, if not identical, to the documents provided in similar cases, including Auto-Owners , 2018 WL 1953861, State Farm , 2018 WL 2392827, and MSPA Claims 1, LLC v. United Auto. Ins. Co. , 204 F.Supp.3d 1342 (S.D. Fla. Aug. 29, 2016).

Plaintiffs seek double damages under Section 1395y(b)(3)(A) because of Defendant's alleged failure to reimburse Plaintiffs' purported Assignors and damages for breach of contract for "failure to pay PIP benefits." (DE 49 at 30-31).

II. STANDARD OF REVIEW

a. Subject Matter Jurisdiction

A challenge to subject matter jurisdiction under Rule 12(b)(1) of the Federal Rules of Civil Procedure may be presented as either a facial or factual attack. McElmurray v. Consol. Gov't of Augusta-Richmond Cty. , 501 F.3d 1244, 1251 (11th Cir. 2007). Facial attacks challenge subject matter jurisdiction based on the allegations in the complaint, which the district court takes as true when considering the motion. Lawrence v. Dunbar , 919 F.2d 1525, 1529 (11th Cir. 1990). In contrast, factual attacks challenge the existence of subject matter jurisdiction in fact, and in such cases "no presumptive truthfulness attaches to plaintiff's allegations." Id. The Eleventh Circuit has held that "the party invoking the court's jurisdiction bears the burden of proving, by a preponderance of the evidence, facts supporting the existence of federal jurisdiction." McCormick v. Aderholt

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Bluebook (online)
322 F. Supp. 3d 1273, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mspa-claims-1-llc-v-liberty-mut-fire-ins-co-flsd-2018.