Sunday, February 18, 2018

MAO-MAOing the insurance industry and catching flak

The Florida Medicare MAOists are spreading nationwide. See our previous postings about these entities, which had previously limited their activities to Florida - 1 - 2 - 3.

At least 14 different lawsuits have been filed in several Federal district courts by a company called MAO-MSO Recovery II, LLC and by related companies. The following listing is taken from the most recent decision of the court in the case filed in the Western District of Wisconsin. In no case has the company been permitted to proceed. In a couple of cases, the complaint has been dismissed outright. In others, a motion to dismiss is pending or has been granted, with leave granted to amend the complaint.
  • MAO-MSO Recovery II, LLC v. Allstate, No. 17-cv-2370 (N.D. Ill.) (motion to dismiss pending); 
  • MAO-MSO Recovery II, LLC v. Erie Indemnity Co., No. 17-cv-81 (W.D. Pa.) (motion to dismiss pending); 
  • MAO-MSO Recovery II, LLC v. Farmers Ins. Exch., No. 17-cv-2559 (C.D. Cal.) (motion to dismiss granted with leave to replead); 
  • MAO-MSO Recovery II, LLC v. GEICO, No. 17-cv-964 (D. Md.) (motion to dismiss pending); 
  • MAO-MSO Recovery II, LLC v. Liberty Mut. No. 17-cv-10564 (D. Mass.) (amended complaint filed); MAO-MSO Recovery II, LLC v. Mercury Gen., No. 17-cv-2557 (C.D. Cal.) (motion to dismiss granted with leave to replead); 
  • MAO-MSO Recovery II, LLC v. Nationwide, 17-cv-00263 (S.D. Ohio) (motion to dismiss pending); 
  • MAO-MSO Recovery II, LLC v. Progressive, No. 17-cv-686 (N.D. Ohio) (motion to dismiss pending); 
  • MAO-MSO Recovery II, LLC v. State Farm, No. 17-cv-321 (S.D. Ill.) (motion to granted with leave to replead); 
  • MAO-MSO Recovery II, LLC v. USAA, No. 17-cv-21289 (S.D. Fla.) (motion to dismiss pending); 
  • MAO-MSO Recovery II, LLC v. USAA Cas. Ins. Co., No. 17-20946-CIV (S.D. Fla.) (motion to dismiss granted with leave to replead); 
  • MAO-MSO Recovery II, LLC v. Boehringer Ingelheim Pharm., Inc., No. 17-cv-21996-UU (S.D. Fla.) (motion to dismiss granted with leave to replead). 
None of the cases, it appears, relate to any actual claims or lawsuits in which Medicare expenses are involved. Rather, they are complaints which purport to state a class action claim against a single insurance company, alleging that the company has settled lawsuits brought by enrollees in unidentified Medicare Advantage plans, that the reimbursement rights of the MA plans have been disregarded in the settlements, that reimbursement money is owed, and that the plaintiff entity is the assignee of the rights of the MA plan.

In the Wisconsin case, the motion to dismiss, filed by Sidley & Austin on behalf of defendant American Family Insurance Company, is based on a lack of standing argument. (Note: There is a technical problem with the text of the linked opinion, in the "Overview of claims and contentions" section.)
First, defendants say that plaintiffs have not adequately alleged that they have standing to sue because the complaints do not include facts showing that they have a valid assignment from a particular MAO as to any particular claim against either defendant. Second, defendants say that plaintiffs have not adequately alleged the elements of their claims, including that defendants were the primary payer of a particular medical expense, that defendants failed to a pay a particular medical expense that they were required to pay, that a particular MAO paid a particular claim, or that a particular beneficiary was a member of a particular MAO.
The court, District Judge James D. Peterson, has dismissed the complaint but (like many of the other District Courts) has given MAO-MSO an opportunity to amend its complaint to see if it can come up with a better (and legally cognizable) statement of a claim.

No comments:

Post a Comment