Court Decision Strengthens MAO’s Ability To Recover

Court agrees with MSP Recovery on demonstrated responsibility and further strengthens a Medicare Advantage Organization’s (“MAO”) ability to recover monies.

On June 24, 2015, the U.S. District Court, Southern District of Florida, ruled in MSP Recovery’s favor in the case styled “MSP Recovery, LLC v. Allstate Insurance Company”.

The claim arose from a motor vehicle accident, in which Allstate, as primary insurer, refused to pay the beneficiary’s medical bills, and as the result, the beneficiary’s HMO was forced to cover his medical expenses associated with the accident.

MSP Recovery was able to ”demonstrate” Allstate’s “responsibility” under the MSP Act, (Medicare Secondary Payer Act) to the Court. The Court held that a “plaintiff can demonstrate a primary plan’s responsibility to pay for an enrollee’s medical expenses via a contractual obligation that a defendant (Allstate) owed to its enrollee and not just through judgment or settlement agreement”.

The court’s ruling is consistent with CMS’ Medicare Secondary Payer Manual, the Code of Federal Regulations, the Secretary of the U.S. Department of Health and Human Services’ opinions and the Sixth Circuit’s opinion in Bio-Medical Application of Tenn v. Cent. States SE & SW.

The court’s ruling further strengthens an MAOs ability to recover payments that a primary payer, such as Allstate, should have paid related to an automobile accident.