Wilson v. United States

58 Fed. Cl. 760, 2003 U.S. Claims LEXIS 371, 2003 WL 22904309
CourtUnited States Court of Federal Claims
DecidedDecember 4, 2003
DocketNo. 03-635C
StatusPublished
Cited by8 cases

This text of 58 Fed. Cl. 760 (Wilson v. United States) is published on Counsel Stack Legal Research, covering United States Court of Federal Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wilson v. United States, 58 Fed. Cl. 760, 2003 U.S. Claims LEXIS 371, 2003 WL 22904309 (uscfc 2003).

Opinion

ORDER

MILLER, Judge.

This case is before the court after argument on defendant’s motion to dismiss for lack of subject matter jurisdiction pursuant to RCFC 12(b)(1). Plaintiff is the representative of a Medicare recipient’s estate. The Medicare recipient received medical services that were covered and paid for by Medicare. After the estate settled a tort claim for medical malpractice, Medicare claimed entitlement to a portion of the settlement, which plaintiff duly paid. Plaintiff now seeks return of the money that she remitted to Medicare on the ground that it was demanded improperly, and therefore constitutes an illegal exaction under the applicable statutes, and deprived her of due process of law under the Fifth Amendment to the U.S. Constitution.

FACTS

The relevant undisputed facts derive from the complaint and are construed in a light most favorable to plaintiff. As personal representative to the estate of Max E. Wilson, Laura Wilson (“plaintiff’) filed a medical malpractice claim against two doctors and a hospital concerning the care of Mr. Wilson, now deceased. Mr. Wilson was eligible for and did receive Medicare benefits for the [761]*761medical care that led to the malpractice claim.

Medicare, enacted in 1965, is a federally funded health insurance program for the aged, disabled, and persons suffering from a specified disease. See 42 U.S.C. §§ 1395-1396b (2000). While Medicare initially was the primary payer for covered care, after 1980 Congress began enacting statutes designed to stem the increasing costs of the program. See H.R.Rep. No. 96-1167 (1980), U.S.Code Cong. & Admin.News 1980, p. 5526. Medicare as Secondary Payer (“MSP”) statutes require liability, automobile, and no-fault insurance to make primary payments for care, with Medicare acting as a secondary payer. See 42 U.S.C. § 1395y(b).

MSP provisions decrease Medicare payments through two mechanisms. First, MSP provisions prevent Medicare from making payments for covered medical care if payment already has been made or reasonably is expected to be made by another source. 42 U.S.C. § 1395y(b)(2)(A)(i). Thus, Medicare effectively is relieved from making payments when the medical care is covered under “workmen’s compensation law or ... an automobile or liability insurance policy ... or under no fault insurance.” 42 U.S.C. § 1395y(b)(2)(A)(ii). Second, MSP provisions allow Medicare to make a payment under the first provision, but require Medicare to be repaid. 42 U.S.C. § 1395y(b)(2)(B)(i). Under this second provision, Medicare may make a payment for medical care that is covered by another health-care plan under 42 U.S.C. § 1395y(b)(2)(A), but Medicare must be reimbursed when the primary insurer makes payments for the medical care. Medical care thus is secured for a Medicare-eligible person whose care is covered by an insurer that should be the primary payer, but has not resolved the claim timely enough to pay for the medical care at the time payment is due. When such an event occurs, Medicare may pay for the care, and the MSP statutes obligate the other insurer, once payment for the care is approved, to reimburse Medicare.

The defendants in the medical malpractice suit settled plaintiffs claim on May 13, 2002. The Department of Health and Human Services (“HHS”) determined that Medicare made $147,057.38 in conditional payments for the care of Mr. Wilson. By letter dated June 30, 2002, Medicare claimed a “lien” on the settlement and sought recovery of $88,-744.721 from plaintiff for payments made by Medicare for Mr. Wilson. HHS took the position that the MSP provisions require plaintiff to repay Medicare proceeds from the malpractice settlement. Plaintiff agreed to settle Medicare’s claim for reimbursement on November 5, 2002, by repaying $48,277.33.

Plaintiff filed this suit to recover the $48,277.33 payment made to Medicare, alleging that no overpayment existed and that the Government was not entitled, under the MSP provisions, to a share of the settlement from the malpractice claim.2

DISCUSSION

1. Standard of review

Defendant moves to dismiss plaintiff’s complaint under RCFC 12(b)(1) for lack of subject matter jurisdiction. The burden of establishing the court’s subject matter jurisdiction rests with the party seeking to invoke it, Myers Investigative & Sec. Sens., Inc. v. United States, 275 F.3d 1366, 1369 (Fed.Cir. 2002), as federal courts are presumed to lack jurisdiction unless the record affirmatively indicates to the contrary, Renne v. Geary, 501 U.S. 312, 316, 111 S.Ct. 2331, 115 L.Ed.2d 288 (1991). When a federal court hears such a jurisdictional challenge, “its task is necessarily a limited one.” Scheuer v. Rhodes, 416 U.S. 232, 236, 94 S.Ct. 1683, 40 L.Ed.2d 90 (1974). “The issue is not whether [762]*762a plaintiff will ultimately prevail but whether the claimant is entitled to offer evidence to support the claims.” Id.

The court must accept as true the facts alleged in the complaint, Reynolds v. Army & Air Force Exch. Serv., 846 F.2d 746, 747 (Fed.Cir.1988), and must construe such facts in the light most favorable to the pleader, Henke v. United States, 60 F.3d 795, 797 (Fed.Cir.1995) (holding courts obligated “to draw all reasonable inferences in plaintiffs favor”). However, the court may consider all relevant evidence, including evidentiary matters outside the pleadings, when resolving a jurisdictional challenge. Indium Corp. of America v. Semi-Alloys, Inc., 781 F.2d 879, 884 (Fed.Cir.1985).

2. Jurisdiction

Plaintiffs complaint grounds subject matter jurisdiction under the Tucker Act, 28 U.S.C. § 1491(a)(1) (2000), which authorizes the Court of Federal Claims to “render judgment upon any claim against the United States founded either upon the Constitution, or any Act of Congress or any regulation of an executive department, or upon any express or implied contract with the United States, or for liquidated or unliquidated damages in cases not sounding in tort.”

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Bluebook (online)
58 Fed. Cl. 760, 2003 U.S. Claims LEXIS 371, 2003 WL 22904309, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wilson-v-united-states-uscfc-2003.