MSPA Claims 1, LLC v. Tenet Florida, Inc., 918 F.3d 1312

FHCP (a Medicare Advantage Organization) covered an enrollee who received treatment at St. Mary’s after a 2013 car accident; Allstate was the primary insurer and St. Mary’s billed both Allstate and FHCP and was paid by both.
St. Mary’s later reimbursed FHCP about $286, but the reimbursement was delayed by seven months; FHCP assigned its MSP Act claims to La Ley, which assigned them to MSPA Claims 1, LLC (MSPA).
MSPA sued St. Mary’s and Tenet (the hospital group) under the Medicare Secondary Payer (MSP) Act for delayed reimbursement; the district court dismissed for failure to state a claim and MSPA appealed.
The Eleventh Circuit considered standing (assignor injury and validity of assignment) and the merits (whether the MSP Act’s private cause of action permits suits against providers rather than only primary plans).
The court held MSPA had Article III standing (FHCP suffered a concrete injury from delayed reimbursement and the assignment chain was validated by a settlement), but the private cause of action under 42 U.S.C. § 1395y(b)(3)(A) permits suits only against primary plans, not medical providers—so dismissal was affirmed.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Standing — injury-in-fact	Delay in reimbursement (7 months) caused concrete economic harm (lost use of funds; entitlement to interest/double damages)	No injury because FHCP was eventually paid in full	Held: Delay is a concrete economic injury; FHCP had injury-in-fact
Standing — validity of assignment chain	FHCP validly assigned MSP claims to La Ley, which assigned to MSPA; settlement resolved any dispute	Chain defects and FHCP receivership repudiated earlier assignment	Held: Settlement before filing cured chain problems; assignment supports standing
Standing — effect of contract anti-assignment clause	MSP Act claim is statutory (outside the Services Agreement) and not barred by contractual anti-assignment clause	Services Agreement forbids assignment without Tenet’s consent, invalidating assignment	Held: Anti-assignment clause applies only to assignment of the Agreement, not to separate statutory MSP Act claims; clause does not defeat standing
Merits — who is suable under MSP Act private cause	The private cause of action should encompass entities (like providers) that receive primary-plan payments and fail to reimburse	Statute authorizes private suits only against primary plans; government’s broader cause covers other entities	Held: The private cause of action is limited to primary plans; MAO/assignee cannot sue providers under § 1395y(b)(3)(A); claim dismissed

MSP Recovery, LLC v. Allstate Ins. Co., 835 F.3d 1351 (11th Cir. 2016) (interpreting MSP Act private cause of action as against primary plans)
Humana Medical Plan, Inc. v. Western Heritage Ins. Co., 832 F.3d 1229 (11th Cir. 2016) (describing MAO/Medicare secondary-payer framework)
Glover v. Liggett Group, Inc., 459 F.3d 1304 (11th Cir. 2006) (standing and limits on suing under MSP Act until primary plan responsibility is demonstrated)
Lujan v. Defenders of Wildlife, 504 U.S. 555 (1992) (defining injury-in-fact for Article III standing)
Spokeo, Inc. v. Robins, 136 S. Ct. 1540 (2016) (concreteness requirement and analogy to traditional harms)
Davidson v. Capital One Bank (USA), N.A., 797 F.3d 1309 (11th Cir. 2015) (pleading-stage review standard for plausibility)