Court Clarifies Applicability of Limitation Period for Private Medicare Secondary Payer Act Cause of Action | Rumberger | Church


RumbergerKirk’s attorneys, Nicole Smith, Samantha Duke and Jeffrey Grosholz, obtained a final summary judgment in MSPA Claims 1, LLC v. Tower Hill Prime Insurance Co. in the United States District Court for the Northern District of Florida. The plaintiff, an alleged three times revoked assignee of a now defunct Medicare Advantage organization, sued Tower Hill Prime Insurance Company and Tower Hill Claims Services, LLC, for double damages under the Medicare Secondary Payer Act. The claimant asserted that Tower Hill was a principal payer under the Act, but that it had not made payments for Medicare covered services provided to the original transferor’s enlisted person. It was one of a plethora of class actions that the plaintiff and its related entities have filed in Florida, as well as elsewhere across the country, seeking recovery under the Medicare Secondary Payer Act for payments. that entities such as Tower Hill should have paid.

The plaintiff’s case was based on a single claim from a Medicare Advantage registrant, although he claimed to have more. The plaintiff’s early attempts to force Tower Hill into a data match which the plaintiff claimed would prove the existence of these other alleged allegations were dismissed by the court. After a thorough discovery, both parties applied for summary judgment. The applicant also applied for class certification. Following a hearing on the concurrent summary judgment motions, the court requested further information on the applicable limitation period. Namely, the limitation period for the federal government’s cause of action under the Medicare Secondary Payer Act is three years, while the law is silent on the limitation period for the private cause of action. The court thus asked the parties to argue on what the applicable limitation period should be. Both parties submitted additional information on the matter, with Tower Hill arguing, in part, that the government’s three-year limitation period should be borrowed while the claimant argued that the six-year limitation period applicable to Actions brought under the false claims law should be used.

After consideration, the court allowed and partially dismissed Tower Hill’s motion for summary judgment, finding that Tower Hill Claims Services, as third party administrator, was entitled to summary judgment. But the court rejected Tower Hill’s argument that the government’s three-year limitation period was applicable; however, the court left open the question of the applicable limitation period. Tower Hill then requested a reconsideration, arguing that if the court borrowed from state law, that is, if it used Florida’s general limitation law, a four-year limitation would apply. and the plaintiff’s claim would still be statute-barred. The court decided to interpret Tower Hill’s petition for reconsideration as a new motion for summary judgment and allowed the parties to provide additional information on the matter.

On the eve of the hearing on the plaintiff’s motion for group certification, the court issued an order granting Tower Hill’s motion for summary judgment. Specifically, the court found that Florida’s statute of limitations was more analogous to the private Medicare Secondary Payer Act cause of action than the False Claims Act, and therefore a four-year statute of limitations. applied. After determining the appropriate limitation period, the court concluded that the plaintiff’s case could not survive because apart from his unique and prescribed exemplary claim, the plaintiff could not invoke any other specific claim. As such, the court concluded that Tower Hill was entitled to a final summary judgment.

The court’s decision is significant in that it represents one of the few instances where a court has analyzed – and effectively answered – the issue of the applicable limitation period in a case brought under the private cause of action of the Medicare Secondary Pay Act. This is remarkable because, although the passage of the PAID Act in December 2020 made it easier for primary payers to learn of the existence of Medicare Advantage organizations and, hopefully, to avoid instances where enrollees were charged. are not reimbursed by the appropriate entity. – the continued absence of a statute of limitations for the private cause of action in the language of the Medicare secondary payer law itself means that entities must always turn to the courts and the jurisprudence for this answer. Accordingly, this ruling in favor of Tower Hill serves as a marker that entities can put forward to defend claims such as these.


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