Aetna Life Insurance Company v. Big Y Foods, Inc., 52 F.4th 66

Nellina Guerrera, a Medicare beneficiary enrolled in an Aetna Medicare Advantage plan, was injured at a Big Y supermarket; providers billed > $48,000, Aetna paid $9,854.16 and Guerrera paid $1,000.
Guerrera sued Big Y; Big Y settled with Guerrera for $30,000 and Guerrera executed a general release that denied Big Y’s liability.
Aetna asserted an MSP Act lien and demanded reimbursement of the $9,854.16; Big Y refused and Aetna sued under the MSP Act private cause of action, seeking double damages.
The district court held (1) MAOs may sue under 42 U.S.C. § 1395y(b)(3)(A), (2) a tortfeasor (insured or self-insured) can be a “primary plan,” and (3) a settlement resolving a claim that included medical expenses demonstrates the tortfeasor’s responsibility to reimburse; it awarded double damages ($19,708.32).
Big Y appealed; the Second Circuit affirmed, holding MAOs can invoke the MSP private cause of action and that Big Y, as a self-insured tortfeasor who settled Guerrera’s claims knowing of Aetna’s lien, was liable as a primary plan.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether an MAO (Aetna) may sue under the MSP Act private cause of action, 42 U.S.C. § 1395y(b)(3)(A).	The statute is broad and unambiguous; nothing excludes MAOs, and Part C is part of the Medicare scheme. MAOs may recover double damages.	Private cause of action was meant for government only (references to Secretary/Trust Fund) and MAOs have other remedies (right-to-charge); allowing MAOs suits merely enriches private entities.	Affirmed: MAOs may sue under §1395y(b)(3)(A); statutory text, structure, purpose, and circuit precedent support MAO access.
Whether a self-insured tortfeasor (Big Y) that settled with a beneficiary (while knowing of MAO's lien) is a “primary plan” responsible for reimbursing the MAO despite a general release and denial of liability.	Aetna: Guerrera’s suit sought medical expenses; settlement resolved those claims; §1395y(b)(2)(B)(ii) permits demonstration of responsibility by a payment conditioned on release.	Big Y: Settlement was a nuisance resolution; medical expenses were not explicitly allocated, and denial of liability/ general release precludes responsibility to reimburse Aetna.	Affirmed: A tortfeasor (insured or self‑insured) can be a "primary plan," and a settlement releasing claims that included medical expenses—coupled with knowledge of the MAO lien—suffices to demonstrate responsibility to reimburse.

Humana Med. Plan, Inc. v. W. Heritage Ins. Co., 832 F.3d 1229 (11th Cir. 2016) (MAOs may sue under MSP Act private cause of action)
In re Avandia Mktg., Sales Pracs. & Prods. Liab. Litig., 685 F.3d 353 (3d Cir. 2012) (private cause of action authorizes MAO recovery from primary payers)
Taransky v. Sec'y of U.S. Dep't of Health & Human Servs., 760 F.3d 307 (3d Cir. 2014) (settlement releasing tortfeasor suffices to demonstrate responsibility to reimburse Medicare)
Chevron U.S.A., Inc. v. Nat. Res. Def. Council, Inc., 467 U.S. 837 (1984) (agency deference framework)
Sebelius v. Cloer, 569 U.S. 369 (2013) (stop inquiry when statutory language is unambiguous)
Anderson v. Liberty Lobby, Inc., 477 U.S. 242 (1986) (summary judgment / genuine issue standard)
Thomas Jefferson Univ. v. Shalala, 512 U.S. 504 (1994) (context on Medicare statutory scheme)