THIS MATTER is before the Court on Defendant Liberty Mutual Fire Insurance Company's ("Defendant") motion to dismiss the Plaintiffs' ("Plaintiffs") third amended complaint for lack of subject matter jurisdiction and failure to state a claim (DE 51), to which Plaintiffs filed a response in opposition (DE 58), and to which Defendant filed a reply (DE 60). For the reasons set forth below, Defendant's motion to dismiss (DE 51) is GRANTED WITH PREJUDICE
I. BACKGROUND
This lawsuit arises under the Medicare Secondary Payer ("MSP") provisions of the Medicare Act, 42 U.S.C. § 1395y et seq. Plaintiffs' class action complaint against Defendant is one of numerous similar actions filed by Plaintiffs in courts
Defendant argues, among other things, that Plaintiffs lack standing to bring this case because (a) "the Complaint does not allege that any of the putative assignors are (1) a Medicare beneficiary; (2) an MAO; or a (3) direct healthcare provider to the Medicare beneficiary;" (b) the "original plaintiff, MSPA Claims I, LLC ("MSPA [Claims]"), lacked standing when the lawsuit was filed ... [and] cannot amend to add new plaintiffs;" and (c) "the Complaint does not support that Plaintiffs have standing under the putative assignments because, among other reasons, the agreements are not assignments." (DE 51 at 2). Defendant also presents several other arguments as to why Plaintiffs have failed to state a claim under Federal Rule of Civil Procedure 12(b)(6) but, because this case must be dismissed for lack of subject matter jurisdiction, we need not address the merits of Defendant's other arguments.
As the alleged assignee of FHCP, HFAP, and IMCG (the "Assignors"), Plaintiffs bring three representative claims. (DE 49 at 5-7). B.T., M.H., and ST. were Medicare beneficiaries (the "Beneficiaries") who were enrolled in Medicare Advantage plans managed by FHCP, FHAP, and IMCG, respectively.
Plaintiffs seek double damages under Section 1395y(b)(3)(A) because of Defendant's alleged failure to reimburse Plaintiffs' purported Assignors and damages for breach of contract for "failure to pay PIP benefits." (DE 49 at 30-31).
II. STANDARD OF REVIEW
a. Subject Matter Jurisdiction
A challenge to subject matter jurisdiction under Rule 12(b)(1) of the Federal Rules of Civil Procedure may be presented as either a facial or factual attack. McElmurray v. Consol. Gov't of Augusta-Richmond Cty. ,
Article III standing has three elements: "[t]he plaintiff must have (1) suffered an injury in fact, (2) that is fairly traceable to the challenged conduct of the defendant, and (3) that is likely to be redressed by a favorable judicial decision." Spokeo, Inc. v. Robins , --- U.S. ----,
b. The Medicare Secondary Payer Act ("MSPA") and Medicare Advantage Organizations
The Court in Auto-Owners set forth a thorough history of the MSPA:
Congress enacted the Medicare Act in 1965 to establish a health insurance program for the elderly and disabled. At that time, Medicare paid for medical expenses even when Medicare beneficiaries were also enrolled in third-party insurance policies that covered those same costs. See MSP Recovery, LLC v. Allstate Ins. Co. ,, 1354 (11th Cir. 2016). In an effort to reduce costs, Congress passed the MSPA in 1980 which made Medicare the secondary payer, rather than the primary payer, for medical services provided to its beneficiaries when they are covered for the same services by a private insurer. See § 1395y(b)(2). Thus, the private insurer becomes the primary payer, as defined by the statute, for medical services. However, when a primary payer cannot be expected to make a payment for a service promptly, Medicare may make conditional payments. § 1395y(b)(2)(B)(i). Once notified of its responsibility for a payment, a primary payer must reimburse Medicare for any payment made within 60 days. § 1395y(b)(2)(B)(ii). In an effort to enforce this scheme, the MSPA created a private cause of action for double damages when a primary plan fails to provide payment. See § 1395y(b)(3)(A). 835 F.3d 1351
Auto-Owners ,
III. DISCUSSION
Plaintiffs are not MAOs, Medicare beneficiaries, or direct health care providers. Rather, as in other cases involving the same Plaintiffs and the same causes of action, Plaintiffs allege that they have obtained claims for reimbursement via assignments from the Assignors. In order to demonstrate a valid assignment, and therefore a valid right to pursue these claims, Plaintiffs provided the Court with the recovery agreements and assignment agreements discussed in Section I above. (DE 49-H; DE 49-L; DE 49-N). Plaintiffs, however, are not a party to all of these contracts.
Defendant argues that this case should be dismissed because Plaintiff MSPA Claims lacked standing at the time the lawsuit was filed. (DE 51 at 6). Defendant supports this argument by contending that because "MSPA originally sued as an alleged assignee of FHCP," (DE 6-46 at 1), "whether MSPA has standing depends on whether MSPA in fact received a valid assignment from FHCP." (DE 51 at 6) (citing MSPA Claims 1, LLC v. Covington Specialty Ins. Co. ,
The Court agrees with Defendant. Plaintiffs do not have standing to bring this suit for two reasons: first, Plaintiff MSPA Claims lacked standing when this lawsuit was originally filed and, thus, cannot amend in an attempt to confer standing on the newly-added Plaintiffs; second, Plaintiffs have failed to allege facts sufficient to show that any of the alleged Assignors have standing under the MSPA.
A. Plaintiff MSPA Claims lacked standing at the time this action was filed
MSPA Claims first brought this lawsuit as an alleged assignee of FHCP. (DE 6-2 at 1). Various courts in this District have addressed Plaintiff's standing as a purported assignee of FHCP and have found that Plaintiff MSPA Claims "lacks standing to assert FHCP's claims because it has not been validly assigned the right to do so."
The facts surrounding FHCP's purported assignment to MSPA Claims are the same in each of these cases, and are set forth in one of this Court's prior orders dismissing a similar case for the same reason, MSPA Claims 1, LLC v. United Auto. Ins. Co. ,
1.2 Term: The term of this Agreement shall be for one (1) year from the date of execution herewith, with an automatic renewal for an additional one (1) year period unless terminated at any time by the parties with ninety (90) day prior written notification. La Ley Recovery may assign the Agreement in whole or in part but the assignee must be approved by the Client .
(DE 49-H at 3). The La Ley Agreement defines "Client" as FHCP. Id. at 2.
In this case, as in MSPA v. United , the third amended complaint fails to allege that FHCP approved Plaintiff's assignment. Thus, based on Defendant's facial challenge, Plaintiff does not have standing to bring this action because it does not hold a valid assignment. See MSPA v. United (citing MSPA Claims 1, LLC v. Nat'l Specialty Ins. Co., et al. , No. 16-CV-20401-MGC, DE 61,
The Court further finds, as it did in MSPA v. United , that Defendant's factual challenge to Plaintiff's standing as an assignee is also meritorious. La Ley and Florida's Department of Financial Services ("DFS"), in its capacity as FHCP's receiver, engaged in a lengthy dispute regarding the La Ley Agreement. Specifically, in the order appointing DFS as FHCP's receiver, which is dated December 10, 2014, DFS repudiated the La Ley Agreement. (DE 6-42 at 46). DFS then repeatedly repudiated the La Ley Agreement by letters dated February 5, 2015, April 23, 2015, and June
Because Plaintiffs have not shown that MSPA Claims had standing-by virtue of FHCP assigning its claims to La Ley, which in turn allegedly assigned them to MSPA Claims-Plaintiff MSPA Claims lacks standing to bring any claims on behalf of FHCP as its assignee. "Article III standing must be determined as of the time at which the plaintiff's complaint is filed." Focus on the Family v. Pinellas Suncoast Transit Auth. ,
B. Plaintiffs have failed to adequately allege that any purported assignor has standing
In their response to the motion to dismiss, Plaintiffs allege that FHCP, HFAP, and IMCG "all are MAOs or direct healthcare providers." (DE 58 at 3).
i. FHCP
First, as numerous other courts in this District have noted, FHCP is not an MAO or a direct healthcare provider but, rather, "a now-defunct health maintenance organization." See, e.g., MSPA Claims 1, LLC v. United Auto. Ins. Co. ,
ii. HFAP
As for HFAP, this Court, and other courts in this District, have explained that the Plaintiffs' attempts to characterize HFAP as an MAO are disingenuous. See, e.g., MSP Recovery Claims, Series LLC v. Travelers Cas. and Surety Co. , No. 1:17-cv-23628-KMW,
iii. IMCG
Finally, regarding IMCG, the recovery agreement Plaintiffs attached to the third amended complaint, (DE 49-N at 8), is between MSP Recovery, LLC-an entity
Because Plaintiffs have failed to adequately allege that the Assignors are entities with standing to sue under Eleventh Circuit precedent,
In Auto-Owners , the Court stated that "[w]hile Plaintiff's theory is that § 1395y(b)(3)(A) allows any private entity to bring a claim, the Eleventh Circuit has determined that § 1395y(b)(3)(A) is not a qui tam statute that authorizes any private person to sue on behalf of the government." Auto-Owners ,
There is established a private cause of action for damages (which shall be in an amount double the amount otherwise provided) in the case of a primary plan which fails to provide for primary payment (or appropriate reimbursement) in accordance with paragraphs (1) and (2)(A).
§ 1395y(b)(3)(A). "Because the statute is silent, courts have interpreted the meaning of "private cause of action" to identify who may assert a claim. Auto-Owners ,
Here, as in Auto-Owners and State Farm , Plaintiffs have failed to sufficiently allege that the Assignors have standing under § 1395y(b)(3)(A). As noted in Auto-Owners , this is a "fatal defect" because "Plaintiff's assignors simply are not within the purview of parties who can bring a claim under § 1395y(b)(3)(A)." Auto-Owners ,
IV. CONCLUSION
For the reasons set forth above, the Court finds that Plaintiffs have failed to establish subject matter jurisdiction. Federal Rule of Civil Procedure 12(h)(3) requires that "[i]f the court determines at any time that it lacks subject-matter jurisdiction, the court must dismiss the action." Fed. R. Civ. P. 12(h)(3). Accordingly, it is ORDERED AND ADJUDGED that Defendant's motion to dismiss (DE 51) is GRANTED and this action is DISMISSED WITH PREJUDICE for lack of subject matter jurisdiction.
DONE AND ORDERED in Chambers in Miami, Florida, this 31st day of July, 2018.
Notes
As the Court in MSP Recovery Claims, Series LLC v. Auto-Owners Ins. Co. , No. 17-23841-PAS,
Therefore, because Plaintiffs fail to allege standing to sue and this Court has already provided Plaintiffs with multiple opportunities to properly plead their claims, the motion to dismiss is granted with prejudice.
See, e.g., MAO-MSO Recovery II, LLC v. Am. Family Mut. Ins. Co. , No. 17-CV-175-JDP,
See Humana v. Medical Plan Inc. v. Western Heritage Ins. Co. ,
As the Court in State Farm noted, "typically, when cases are dismissed for lack of subject matter jurisdiction, dismissal is without prejudice." State Farm ,
