Stalley v. Wellmont Health

CourtCourt of Appeals for the Sixth Circuit
DecidedFebruary 28, 2008
Docket07-5360
StatusPublished

This text of Stalley v. Wellmont Health (Stalley v. Wellmont Health) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Stalley v. Wellmont Health, (6th Cir. 2008).

Opinion

RECOMMENDED FOR FULL-TEXT PUBLICATION Pursuant to Sixth Circuit Rule 206 File Name: 08a0097p.06

UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT _________________

X - No. 07-5077 - DOUGLAS B. STALLEY, - Plaintiff-Appellant, - Nos. 07-5077/5147/5358/ v. , 5360/5362/5363/5364 METHODIST HEALTHCARE, > Defendant-Appellee. - - - - No. 07-5147

- DOUGLAS B. STALLEY, - Plaintiff-Appellant, - v. SUMNER REGIONAL HEALTH SYSTEMS, INC., - - - Defendant-Appellee.

- - No. 07-5358 - DOUGLAS B. STALLEY, Plaintiff-Appellant, - - - v.

- ERLANGER HEALTH SYSTEM,

- Defendant-Appellee. - - Nos. 07-5360/5362/5364 DOUGLAS B. STALLEY, - - - Plaintiff-Appellant,

- v.

- WELLMONT HEALTH SYSTEM (07-5360), - MOUNTAIN STATES HEALTH ALLIANCE (07-5362), - THE BAPTIST HEALTH SYSTEM OF EAST TENNESSEE (07-5364), - - - Defendants-Appellees.

- - No. 07-5363 - DOUGLAS B. STALLEY, - Plaintiff-Appellant, v. - - - COVENANT HEALTH,

- Defendant-Appellee.

- N

1 Nos. 07-5077/5147/5358/ Stalley v. Methodist Healthcare, et al. Page 2 5360/5362/5363/5364

Appeal from the United States District Courts for the Western District of Tennessee at Memphis, the Middle District of Tennessee at Cookeville, and the Eastern District of Tennessee at Chattanooga, Greeneville, and Knoxville. Nos. 06-02605; 06-00074; 06-00194; 06-00217; 06-00216; 06-00359; 06-00295— Jon Phipps McCalla, Robert L. Echols, District Judges; Curtis L. Collier, Chief District Judge. Argued: December 4, 2007 Decided and Filed: February 28, 2008 Before: RYAN, BATCHELDER, and GRIFFIN, Circuit Judges. _________________ COUNSEL ARGUED: Kenneth L. Connor, WILKES & McHUGH, Leesburg, Virginia, for Appellant. Edward K.M. Bilich, JONES DAY, Washington, D.C., Daniel M. Stefaniuk, SPEARS, MOORE, REBMAN & WILLIAMS, Chattanooga, Tennessee, John L. Miller, WAGNER, MYERS & SANGER, Knoxville, Tennessee, Reuben N. Pelot IV, EGERTON, McAFEE, ARMISTEAD & DAVIS, Knoxville, Tennessee, for Appellees. ON BRIEF: Kathleen C. Knight, WILKES & McHUGH, Tampa, Florida, for Appellant. Edward K.M. Bilich, Gregory M. Luce, Paul R. Reichert, JONES DAY, Washington, D.C., Daniel M. Stefaniuk, Fred H. Moore, SPEARS, MOORE, REBMAN & WILLIAMS, Chattanooga, Tennessee, Reuben N. Pelot IV, EGERTON, McAFEE, ARMISTEAD & DAVIS, Knoxville, Tennessee, Robert L. Trentham, MILLER & MARTIN, Nashville, Tennessee, Martin B. Bailey, WAGNER, MYERS & SANGER, Knoxville, Tennessee, for Appellees. _________________ OPINION _________________ ALICE M. BATCHELDER, Circuit Judge. Plaintiff-Appellant Douglas B. Stalley (“Stalley”) filed seven separate lawsuits in the district courts in Tennessee — in addition to numerous cases in other jurisdictions against different defendants — claiming that Defendants- Appellees Methodist Healthcare (“Methodist”), Sumner Regional Health Systems, Inc. (“Sumner”), Erlanger Health System (“Erlanger”), Wellmont Health System (“Wellmont”), Mountain States Health Alliance (“Mountain States”), Covenant Health (“Covenant”), and The Baptist Health System of East Tennessee (“Baptist”)1 (collectively referred to as “Appellees”) all violated the Medicare Secondary Payer Act (“MSP”), 42 U.S.C. § 1395y(b). In none of the virtually identical complaints does Stalley allege any direct injury. Instead, the complaints are premised on his belief that the MSP is a qui tam statute granting him standing to sue as a private attorney general. The several district courts, following the clear language of the MSP and a plethora of case law, separately ruled that the MSP is not a qui tam statute and, therefore, Stalley does not have Article III standing to raise these claims. Stalley appeals those decisions. Because we find no basis upon which to hold that the MSP is a qui tam statute, and no basis upon which to find that Stalley can otherwise demonstrate standing, we AFFIRM the judgments of the district courts.

1 Stalley also sued unnamed John Does 1 through 10 in each of the complaints. Nos. 07-5077/5147/5358/ Stalley v. Methodist Healthcare, et al. Page 3 5360/5362/5363/5364

I. BACKGROUND A. Procedural History Stalley sued Appellees complaining that they violated the MSP by failing to reimburse Medicare for unspecified payments that Medicare supposedly advanced to treat unspecified medical errors made with regard to unspecified Medicare beneficiaries at unspecified health care facilities owned by Appellees. Appellees all filed motions to dismiss, asserting that Stalley lacked standing to raise his claim, Fed. R. Civ. Proc. 12(b)(1),2 and that Stalley failed to state a claim upon which relief may be granted, Fed. R. Civ. Proc. 12(b)(6). The District Court for the Eastern District of Tennessee consolidated the actions filed in that district, namely, those against Erlanger, Wellmont, Mountain States, Covenant and Baptist, and dismissed the claims, both because Stalley lacked Article III standing to assert them and because Stalley failed to state a claim upon which relief could be granted. The District Court for the Middle District of Tennessee dismissed Stalley’s complaint against Sumner on the same grounds. Finally, the District Court for the Western District of Tennessee dismissed Stalley’s claim against Methodist, holding that Stalley lacked standing to assert his claim; the court did not address the question of whether Stalley had raised a claim upon which relief could be granted. All of the district courts held that the MSP is not a qui tam statute. Stalley timely appealed all three decisions, and the cases were consolidated for appeal because they raise identical issues of law and fact as to all Appellees. B. The Medicare Secondary Payer Statute Medicare is a federal health insurance program that provides health insurance benefits to people 65 years of age or older, disabled people, and people with end-stage renal disease. 42 U.S.C. § 1395c. For a number of years, Medicare served as the primary payer of health costs for eligible individuals. Mason v. American Tobacco Co., 212 F.Supp.2d 88, 91 (E.D.N.Y. 2002). In 1980, however, Congress enacted the MSP to counteract escalating health-care costs. United Seniors Ass’n v. Philip Morris USA, 500 F.3d 19, 21 (1st Cir. 2007), cert. denied, 2008 U.S. LEXIS 1104 (2008). The MSP “makes Medicare the secondary payer for medical services provided to Medicare beneficiaries whenever payment is available from another primary payer.” Id. “This means that if payment for covered services has been or is reasonably expected to be made by someone else, Medicare does not have to pay.” Cochran v. United States Health Care Fin. Admin., 291 F.3d 775, 777 (11th Cir. 2002). Consequently, the MSP makes Medicare a secondary payer and designates certain private entities — such as a group health plan, a worker’s compensation plan, or an automobile or liability insurance plan — as “primary payers” that have the responsibility to pay for a person’s medical treatment. See Glover v. Philip Morris USA, 380 F.Supp.2d 1279, 1282 (M.D. Fla. 2005); see also 42 U.S.C. 1395y(b)(2)(ii). If the primary payer has not paid and will not promptly do so, however, Medicare can conditionally pay the cost of the treatment. United Seniors, 500 F.3d at 21 (citing 42 U.S.C. § 1395y(b)(2)(B)).

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Stalley v. Wellmont Health, Counsel Stack Legal Research, https://law.counselstack.com/opinion/stalley-v-wellmont-health-ca6-2008.