Guillermina Parra v. Pacificare of Arizona, Inc.
2013 U.S. App. LEXIS 7861
| 9th Cir. | 2013Background
- MAO PacifiCare sought reimbursement from GEICO policy proceeds for payments it made on Parra’s behalf.
- Parra was injured by a car; MAO paid his hospital/medical bills.
- GEICO settled and paid the remainder of the policy; proceeds were held in trust pending dispute.
- Survivors sought injunctive relief and a declaration that PacifiCare has no greater right than the Secretary to recover from wrongful-death proceeds.
- District court dismissed Count II (Medicare Act claim) for failure to state a claim and declined to exercise supplemental jurisdiction over Count I; PacifiCare appealed.
- Court held no private federal right of action for MAOs under the MAO Statute or the Private Cause of Action, and declined to create federal common law or apply complete preemption; jurisdiction to determine private rights exists, but not in this case.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Private right of action under MAO Statute? | PacifiCare contends MAO Statute creates a private right to reimbursement. | Survivors argues MAO Statute merely allows contract-based recovery, not a federal private right of action. | No private right of action under MAO Statute. |
| Private Cause of Action under §1395y(b)(3)(A)? | PacifiCare relies on private action to recover from primary plans. | Gen. primary plan payment and interpleader context show no private action here. | Private Cause of Action does not apply against Survivors; GEICO tendered funds; action against interpleader not allowed. |
| Federal common law/complete preemption basis for Count I? | MAO seeks federal common law or complete preemption to support Count I. | Medicare Act does not create federal common law or complete preemption for this dispute. | No federal common law basis or complete preemption; jurisdiction remains limited. |
| Supplemental jurisdiction? | Count I should be heard under supplemental jurisdiction. | After dismissal of federal claim, district court acted within discretion to dismiss state-law claims. | District court did not abuse discretion; declined supplemental jurisdiction. |
Key Cases Cited
- Care Choices HMO v. Engstrom, 330 F.3d 786 (6th Cir. 2003) (MAO provisions create contract-rights, not private federal actions)
- Nott v. Aetna U.S. Healthcare, Inc., 303 F. Supp. 2d 565 (E.D. Pa. 2004) (MAO provisions do not create a private enforcement mechanism)
- Woods v. Empire Health Choice, Inc., 574 F.3d 92 (2d Cir. 2009) (MSP private causes of action vindicate private rights, not interpleader disputes)
- Bio-Medical Applications of Tenn., Inc. v. Central States Se. & Sw. Areas Health & Welfare Fund, 656 F.3d 277 (6th Cir. 2011) (MSP private action supports private enforcement of medical expenses)
- In re Avandia Mktg., 685 F.3d 353 (3d Cir. 2012) (Addressed private right under §1395y(b)(3)(A) but not dispositive here)
- Thompson v. Thompson, 798 F.2d 1547 (9th Cir. 1986) (Jurisdiction to decide if federal statute creates a right of action; not defeated by eventual merits)
- Western Radio Servs. Co. v. Qwest Corp., 530 F.3d 1186 (9th Cir. 2008) (Established that federal question jurisdiction exists to determine private rights under federal statutes)
- North County Communications Corp. v. Cal. Catalog & Tech., 594 F.3d 1149 (9th Cir. 2010) (Disapproved private right-of-action approach in some contexts; discussed jurisdiction)
- Williams v. United Airlines, Inc., 500 F.3d 1019 (9th Cir. 2007) (Jurisdictional analysis related to federal-question claims)