AUTO CLUB INSURANCE ASSOCIATION v. United States
1:11-cv-00406
Fed. Cl.Mar 20, 2012Background
- Auto Club Insurance Association sued the United States in the Court of Federal Claims seeking reimbursement for Medicare-subjected medical expenses paid on behalf of insured F.H. for an accident in 1977.
- Plaintiff has paid $315,413.64 in medical expenses on F.H.'s behalf since 2005, under Michigan no-fault statute.
- Plaintiff asserts Medicare is the primary payer for pre-1980 accidents and that there is a right to reimbursement flowing from the United States to the no-fault insurer.
- Plaintiff seeks reimbursement since 2005 plus interest, costs, and fees, and argues MSPA/regulations create an implied contract obligating CMS to reimburse.
- Defendant moved to dismiss under RCFC 12(b)(1), asserting MSPA is not money-mandating and no implied contract or illegal exaction supports jurisdiction.
- The court granted the motion to dismiss for lack of subject-matter jurisdiction, finding no money-mandating MSPA language, no implied contract, and no illegal exaction, and noting Congress did not authorize this suit.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is MSPA money-mandating under the Tucker Act? | MSPA creates a reimbursement right from CMS to insurers. | MSPA contains no money-mandating language or entitlement to reimbursement. | MSPA is not money-mandating; no jurisdiction under Tucker Act. |
| Does MSPA give rise to an implied-in-fact contract between CMS and payers? | MSPA statutory-regulatory framework forms mutual obligations implying a contract. | MSPA does not establish an offer/acceptance/consideration; no implied contract. | No implied-in-fact contract; jurisdiction lacking. |
| Can the claim be construed as an illegal exaction under the Tucker Act? | Government has the insurer's money; claim for damages not based on tort. | Illegal exaction requires government to have improperly paid or retained funds. | No illegal exaction; plaintiff did not pay funds to the government under statutorily authorized authority. |
| May the Court of Federal Claims hear this reimbursement claim due to lack of CMS administrative process? | Court is the proper forum in absence of CMS administrative review. | Congress must authorize jurisdiction; cannot be created by the court. | Court cannot create jurisdiction; no congressional consent. |
Key Cases Cited
- United States v. Sherwood, 312 U.S. 584 (1941) (sovereign immunity requires congressional consent to sue)
- United States v. King, 395 U.S. 1 (1969) (waiver of immunity must be unequivocally expressed)
- Testan, 424 U.S. 392 (1976) (Tucker Act is jurisdictional and does not create a substantive money damages claim)
- Baltimore & Ohio R.R. Co. v. United States, 261 U.S. 592 (1923) (implied-in-fact contracts require conduct reflecting meeting of minds)
- Harbert/Lummus Agrifuels Projects v. United States, 142 F.3d 1429 (Fed. Cir. 1998) (elements of express contract required for implied contract claims)
- Trauma Serv. Group v. United States, 104 F.3d 1321 (Fed. Cir. 1997) (requires offer, acceptance, and consideration for implied-in-fact contracts)
- Palmer v. United States, 168 F.3d 1310 (Fed. Cir. 1999) (remedies for back pay claims require congressional authorization; court cannot grant relief without jurisdiction)
- Pan American World Airways v. United States, 129 Ct. Cl. 53 (1954) (illegal exaction requires government to have wrongfully exacted funds)
- Clapp v. United States, 127 Ct. Cl. 505 (1954) (illegal exaction requires improper payment to government)
- Loveladies Harbor, Inc. v. United States, 27 F.3d 1545 (Fed. Cir. 1994) (money-mandating statute analysis for Tucker Act claims)