U.S. Appeals Court Reaffirms Medicare Advantage Plan Rights

On August 30, 2016, the Appellate Court from the U.S. Southern Florida District provided its opinion about whether a contractual obligation, without a judgment or settlement agreement from a separate proceeding, can satisfy the “demonstrated responsibility” requirement of the private cause of action provided for by the Medicare Secondary Payer (MSP) Act.

In MSP Recovery, LLC v. Allstate, et.al., the U.S. Eleventh District Court found that Medicare Advantage Plans may take a “primary plan” insurance company to court for damages under the MSP Act private cause of action. The Court said, “The law defines a “primary plan” as “a group health plan or large group health plan, . . . a workmen’s compensation law or plan, an automobile or liability insurance policy or plan (including a self-insured plan) or no fault insurance . . . .” 42 U.S.C. § 1395y(b)(2)(A).2.  Thus, it is clear that the defendants in this case—which are all personal injury protection no-fault carriers—are primary plans within the meaning of the MSP Act.”

Click here for the full MSP Recovery, LLC v. Allstate, et.al. opinion  >>