Saturday, September 5, 2015

New prospectors looking for gold

The U.S. District Court for the Southern District of Florida has granted a Motion for Dismissal filed under the Medicare statute's private cause of action provision, seeking double recovery damages, arising from a series of treatments for an unnamed insured. The insured was a member of Florida HealthPlan Plus, a Medicare Advantage plan, and the defendant was (it appears) a liability carrier. The nature of the injury and why the defendant was alleged to be responsible to pay were not made clear.

Citing Glover v. Liggett Group, Inc., 459 F.3d 1304, 1308 (11th Cir. 2006), the court noted that the complaint failed to allege that the defendant had an established responsibility to pay under its policy. Absent such an allegation, it found, the complaint did not state a claim on which relief could be granted, and the defendant was entitled to dismissal under Federal Rule 12-b-6.

What is interesting about this lawsuit is the fact that it was filed, not by the Medicare Advantage plan, but by a company called MSPA Claims 1, LLC which asserted that it was an "assignee" of the MA plan's reimbursement claim. A review of the Florida Sunbiz site shows that fifteen separate limited liability companies, the first called "MSPA Claims 1, LLC" and the remainder bearing names "MSPA Claims II" through "MSPA Claims XV," have been registered in that state between February and June 2015. The registered agent for each is Rachel L. Tolley, a Miami lawyer who is nonetheless identified as the Manager of MSP Recovery Services, LLC, in Miami. That company's web site says,
MSP Recovery is an entity that provides recovery services to Health Maintenance Organizations (“HMO”), Management Service Organizations (“MSO”) and Independent Practice Organizations (“IPA”, collectively the “Client”). With its multi-level structure, MSP Recovery, through its proprietary software as well as highly trained staff, which includes IT personnel, accountants, statisticians, physicians, data analysts and attorneys, maximizes the recovery of claims already paid and provides an analysis of which claims the Client was not responsible for pay. MSP Recovery recovers medical services and/or supplies already paid to medical providers and/or shifts claims submitted to the Client to primary payers as required by the Medicare Secondary Payer Act (“MSP”).
MSPA Claims 1, LLC, v. IDS Property Casualty Insurance Company - decided August 28