Humana Insurance Co. v Paris Blank LLP, 187 F.Supp.3d 676 (ED Va. Richmond Division 2016)
A federal court in Virginia this past year ruled that a Medicare Advantage Organization (MAO) was permitted to pursue recovery against a law firm and lawyer for failure to reimburse conditional medical expenses arising out of an automobile accident. The court found that the Medicare Secondary Payer statute created a private cause of action for the MAO to sue the law firm to recover the conditional payments.
The court reasoned:
“Although not binding precedent, this Court finds persuasive the Third Circuit’s determination that a MAO may pursue recovery pursuant to the private right of action in § 1395y(b)(3)(A). Section 1395y(b)(2)(A)’s plain language establishes a private right of action to recover double damages where a primary plan fails to pay. Absent from the plain language of the statute is any restriction upon who may utilize that private right of action.”
“Contrary to Defendants’ position, the law does not carve out exceptions for attorneys and law firms. The statute generally establishes a private cause of action “in the case of a primary plan which fails to provide for primary payment.” 42 U.S.C. § 1395y(b)(3)(A). Much like who may bring an action pursuant to the statute, the plain language fails to limit the parties against whom suit may be maintained.”