By

Alexis Fernandez
Two recent legal decisions out of the Eleventh Judicial Circuit in and for Miami Dade County indicate that Medicare Advantage Organizations (MAOs) may be able to obtain reimbursement from no-fault liability carriers pursuant to Medicare Secondary Payer law on a class-wide basis. On April 20, 2017, the Honorable Judge Antonio Arzola entered a 56-page order...
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After several wins at the U.S. Court of Appeals for the 11th Circuit, MSP Recovery made history again obtaining class certification for Medicare Advantage Organizations based on the principles of Medicare Secondary Payer law, against IDS Insurance Company. On April 20, 2017, the Honorable Judge Antonio Arzola entered a 56-page Order Granting the Motion to...
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On February 2, 2017, Judge Samantha Ruiz-Cohen of the Eleventh Judicial Circuit certified MSPA CLAIMS 1, LLC v. Ocean Harbor Cas. Ins., Case No. 2015-1946-CA-01, as a class action. This is one of more than a dozen cases brought by MSP Recovery in state and federal court challenging the failure of no-fault automobile insurers to...
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Lawyers: 11th Circuit Medicare Ruling Could Be Worth Billions by Katheryn Hayes Tucker A federal appeals court decision analyzing the Medicare Secondary Payer Act could put the nation’s largest automobile insur­ance companies and other providers on the hook to pay billions of dollars in Medicare reimbursement. “This is a humongous victory,” said John Ruiz of...
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11th Circuit Puts Insurers on the Hook to Repay Billions Eleventh Circuit Court Rules Again in Favor of Medicare Advantage Plans: Contract of Insurance Demonstrates Responsibility to Pay Eleventh Circuit Finds Mere Existence Of Insurance Contract Satisfies Condition Precedent To Action For Double Damages Under The Medicare Secondary Payer Act
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The Eleventh Circuit Court of Appeals follows the Third Circuit’s lead by finding a Medicare Advantage Organization (MAO) has a private cause of action to pursue reimbursement under the Medicare Secondary Payer Act (MSP). A case of first impression, Humana Med. Plan v. W. Heritage Ins. Co., touched upon whether the MSP private cause of...
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It should be of no surprise defendants prefer federal courts. Favorable procedural rules, offers of judgment, and unavailability of interlocutory appeals are just some of the reasons why defendants would conclude that a federal court in essence affords them a “home field advantage.” As a result, defense attorneys tirelessly seek removal. In a massive attack...
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Suppose Joe is sixty-nine (69) years old, and while driving down I-95, another vehicle suddenly rear-ends him. Joe has Personal Injury Protection (“PIP”) coverage as part of his automobile insurance, but also an enrollee of a Medicare Advantage (“MA”) health plan offered by a Medicare Advantage Organization (“MAO”). Joe goes to the hospital as a...
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