Timeliness for Suits Filed Under the Medicare Secondary Payer Act (“MSPA”)
In MSPA Claims 1, LLC v. Kingsway Amigo Ins. Co., the 11th Circuit was tasked with answering the question of whether 42 U.S.C. § 1395y(b)(2)(B)(vi) imposes a timeliness requirement with which the government or a private entity must comply as a prerequisite to filing suit to seek reimbursement for payments that it made on behalf of a Medicare beneficiary. The Medicare Secondary Payer Act (the “Act”), codified in 42 U.S.C. § 1395y, states in pertinent part:
“Claims-filing period. Notwithstanding any other time limits that may exist for filing a claim under an employer group health plan, the United States may seek to recover conditional payments in accordance with this subparagraph where the request for payment is submitted to the entity required or responsible under this subsection to pay with respect to the item or service (or any portion thereof) under a primary plan within the 3-year period beginning on the date on which the item or service was furnished.”
42 U.S.C. § 1395y(b)(2)(B)(vi).
Here, the case involved a car wreck on April 29, 2012. One of the individuals injured in the accident was a Medicare beneficiary. The beneficiary in question received her benefits from a Medicare Advantage Organization (“MAO”) that later assigned its claims to the appellant, MSPA Claims 1. The second party involved in the accident had car insurance with the appellee, Kingsway Amigo Insurance. Ultimately, the Medicare beneficiary received $21,965 for medical treatments from its Medicare Advantage plan. The Medicare beneficiary also settled a personal-injury claim with the auto insurer for $6,667. After the settlement, MSPA received the MAO’s recovery rights and sought reimbursement from the auto insurer for the $21,965 that the MAO had already paid. When the auto insurer refused to pay, MSPA took the dispute to court.
The district court ruled in favor of the auto insurer, holding that MSPA’s claim was barred because it did not comply with the three-year requirement found in the claims-filing provision of § 1395y(b)(2)(B)(vi). On appeal, the 11th Circuit reversed holding that the Act does not “erect a separate bar that private plaintiffs must overcome in order to sue.” In other words, by permitting MSPA to sue after three years had elapsed since the MAO had paid claims, the 11th Circuit vitiated a timeliness requirement with which a private entity must comply as a prerequisite for seeking reimbursement for payments that it made on behalf of a Medicare beneficiary. Therefore, compliance with the “3-year period” language found in § 1395y(b)(2)(B)(vi) is not a precondition to filing suit.