UNITED STATES, Plaintiff-Appellant, v. James STRICKER, et al., Defendants-Appellees.
No. 11-14745.
United States Court of Appeals, Eleventh Circuit.
July 26, 2013.
521 F. App‘x 500
Before JORDAN and HILL, Circuit Judges, and HOOD,* District Judge.
PER CURIAM:
The government appeals the district court‘s dismissal of its action under the Medicare Secondary Payer Act,
I
Through Medicare, the United States government supplies medical insurance for persons who are at least 65 years old, disabled, or afflicted by end-stage kidney disease. At times, another person or entity is responsible for the payment of the Medicare beneficiary‘s medical bills—for example, a tortfeasor who caused the beneficiary‘s injuries—yet refuses to swiftly pay those bills. When that happens, the Medicare Secondary Payer Act (“MSPA“),
For decades, from its chemical plant in Anniston, Alabama, the Monsanto Company and its predecessors—including Pharmacia Corporation and Solutia, Incorporated—produced polychlorinated biphenyls (“PCBs“), which are toxic pollutants linked to cancer and birth defects. See Memorandum Opinion at 2 [D.E. 109]. In 1996, thousands of individuals sued Monsanto, Pharmacia, and Solutia (collectively “the PCB producers“) in state and federal courts in Alabama for injuries caused by PCBs. See, e.g., Abernathy v. Monsanto Co., Case No. CV-01-832 (Ala. Cir. Ct.); Tolbert v. Monsanto Co., Case No. CV-01-C-1407-S (N.D. Ala.). Eventually, the parties reached a settlement, whereby the PCB producers would pay $300 million to the plaintiffs in return for their release of liability. More than six years after the PCB producers transferred $275 million to the PCB plaintiffs’ lawyers pursuant to the settlement, but before that money was distributed to the PCB plaintiffs, the government filed suit under the MSPA against the PCB producers, the PCB plaintiffs’ lawyers, and the insurance companies which furnished liability insurance to the PCB producers, seeking to recoup Medicare payments that it had made on behalf of 907 PCB plaintiffs.
As relevant here, the Federal Claims Collection Act provides that when an action is “founded upon [a] contract,” the government must sue within six years of the accrual of the cause of action. See
A
Years after the PCB plaintiffs filed their personal injury lawsuits, the federal district court and the state circuit court hearing their claims held a joint session. At this proceeding, the parties resolved their disputes, and on September 9, 2003, entered into a $300 million settlement agreement.2 By its terms, the agreement outlined a payment schedule whereby the PCB producers would first wire $75 million to an interest-bearing account. Within seven days of the state court‘s approval of the agreement, the PCB producers would wire another $200 million to the account. See Settlement Agreement at ¶ 3(e)-(g) [D.E. 1-1].
Under the terms of the settlement agreement, the PCB plaintiffs’ lawyers were given 90 days to diligently secure a liability release from each client. The PCB plaintiffs’ lawyers were to hold the releases until at least 75% of the adult plaintiffs had released their claims, at which point the PCB plaintiffs’ lawyers had to certify that the 75% threshold had been reached. Once they so certified, the PCB plaintiffs’ lawyers would receive the $275 million.3
Thereafter, the PCB plaintiffs’ lawyers were to certify to the state court when 97% of the PCB plaintiffs had signed releases, and at that point give the releases to the PCB producers. The PCB producers had three days to review the releases and raise any issues of concern. At “the end of this three day verification period or following the resolution [of any issues]” by the state court, if the PCB plaintiffs’ lawyers “ha[d] obtained signed [r]eleases” from at least 97% of the PCB plaintiffs, the PCB plaintiffs’ lawyers were required to “distribute the funds.” See Settlement Agreement at ¶ 13(c).
The agreement had one more germane provision. If, after the 90-day period, fewer than 97% of the PCB plaintiffs had released their claims, the PCB producers,
B
The state court approved the settlement on September 10, 2003. Once approved, the settlement was binding on the parties under Alabama law. See Beverly v. Chandler, 564 So. 2d 922, 923 (Ala. 1990). The events contemplated by the settlement agreement took place as follows:
- August 20, 2003: The parties agreed to a settlement.
- August 26, 2003: The PCB producers transferred $75 million to the interest-bearing account.
- September 9, 2003: The parties signed a written settlement agreement.
- September 10, 2003: The state court approved the settlement agreement.
- September 17, 2003: The PCB producers wired the additional $200 million to the interest-bearing account.
- October 28, 2003: The PCB lawyers certified that 75% of the adult PCB plaintiffs had signed releases.
- October 29, 2003: The PCB producers paid $275 million to the PCB plaintiffs’ lawyers.
- December 2, 2003: The PCB plaintiffs’ lawyers certified that 97% of the PCB plaintiffs had signed releases.
On December 1, 2009, the government filed this lawsuit.
C
The Medicare Secondary Payer Act, as its name implies, is related to the Medicare program, through which the government funds health insurance for certain qualifying individuals. Prior to the Act, Medicare paid for a qualifying individual‘s medical services without regard to whether they were also covered under a separate health plan or other insurance coverage. See Health Ins. Ass‘n of Am. v. Shalala, 23 F.3d 412, 414 (D.C. Cir. 1994). To promote the viability of the Medicare system and reduce expenditures, the Act introduced four features of relevance. See id. at 414-15 (discussing structure of the Act).
First, the Act generally “declares that, under certain conditions, Medicare will be the secondary rather than primary payer for” the medical bills of Medicare beneficiaries. See United States v. Baxter Int‘l, Inc., 345 F.3d 866, 874-75 (11th Cir. 2003).
Second, in instances where the responsible, primary payer4 “has not made or cannot reasonably be expected to make payment ... promptly,” the Act allows Medicare to make a conditional payment for the beneficiary‘s medical services, i.e., a payment conditioned on reimbursement by the primary payer. See
Third, the Act obligates a primary payer that is demonstrably responsible for those
Fourth, if the primary payer—or recipient of a payment from the primary payment—fails to reimburse the government despite its obligation to do so, the Act provides the government with two mechanisms through which to seek recovery: (i) the Act grants the government a right to subrogation,5 to step in and assume the Medicare beneficiary‘s right for payment of medical bills that should have been paid by the primary payer. See
As with most complex concepts, a real-world example helps make the Act‘s contours more clear. Imagine a 65-year-old Medicare beneficiary who is injured when he slips on the wet floor of a supermarket and subsequently receives medical attention for his injuries. If the supermarket‘s negligence caused the man‘s injuries, the supermarket (or its liability insurance carrier) is ultimately responsible for his medical bills. But if the supermarket denies responsibility, litigation may be required to resolve the man‘s negligence claim, and he may not have the money to pay for his medical care in the meantime. Because this is a situation in which the supermarket cannot reasonably be expected to pay promptly, the Act allows Medicare to pay the man‘s medical bills on a conditional basis.
Now imagine that the man and the supermarket settle the negligence claim and that the supermarket‘s insurer pays the settlement funds to the man. To recoup the medical payments Medicare conditionally made, the Act allows the government to sue the insurer (which, because of the settlement, has been demonstrated to be the primary payer), the injured man (who is the recipient of a payment from the primary payment), or both of them. The government can, of course, recover only once, see 54 Fed.Reg. 41716, 41720 (Oct. 11, 1989) (the agency “will not pursue duplicate recoveries“), and if its recovery is against the insurer, the insurer can in turn sue the man to recover the payment it made to him, see Shalala, 23 F.3d at 418 n. 4. See also
D
On December 1, 2009—one day short of six years from the day that the PCB plaintiffs’ lawyers filed the 97% certification
The settlement agreement, the government alleged, demonstrated that the PCB producers and their insurers were responsible for the payment of the medical treatment needed by Medicare beneficiaries as a result of the PCBs produced in Anniston. The government also alleged that Medicare had paid for the PCB-related medical treatment of 907 PCB plaintiffs. According to the government, because the PCB plaintiffs’ lawyers had accepted payment from those responsible for payment of the medical services, they too were liable under the MSPA.
The PCB producers, their insurers, and the PCB plaintiffs’ lawyers moved to dismiss the complaint. They argued that, under
II
When it considers a motion to dismiss under
A
The purpose of a statute of limitations, such as
As relevant here and as noted above,
The government characterizes its MSPA claim as an action founded upon a contract implied in law. If this characterization is correct, the government would have had six years from the date of accrual to bring this action. And, so long as the government‘s claim accrued when the PCB plaintiffs’ lawyers certified that 97% of the PCB plaintiffs had released their claims, the government‘s lawsuit would be timely. The defendants contend, however, that the claim is really an action founded upon a tort, giving the government, only three years from accrual to sue.
We need not, and do not, decide whether the government‘s attempt to recoup Medicare payments under the MSPA after a
B
The accrual of a federal cause of action is a matter of federal law. See Wallace v. Kato, 549 U.S. 384, 388 (2007); Mendiola v. United States, 401 F.2d 695, 697 (5th Cir. 1968). The general rule is that a federal cause of action “accrues once a plaintiff has a ‘complete and present cause of action.‘” Merck & Co., Inc. v. Reynolds, 559 U.S. 633, 130 S.Ct. 1784, 1793 (2010) (citation omitted). “Unless Congress has told us otherwise in the legislation at issue, a cause of action does not become ‘complete and present’ for limitations purposes until the plaintiff can file suit and obtain relief.” Bay Area Laundry & Dry Cleaning Pension Trust Fund v. Ferbar Corp. of Cal., 522 U.S. 192, 201 (1997). As we explain below, Congress and the Secretary of Health and Human Services—who has the authority to “promulgate regulations to carry out” the MSPA, see
1
The MSPA allows the government to “bring an action against any and all entities that are or were required or responsible ... to make payment [for expenses conditionally paid by Medicare] ... under a primary plan.”
In relevant part,
Pursuant to
In our view, both interpretations of the conditioned-upon-release language in
The Secretary of Health and Human Services has issued a regulation,
A primary payer‘s responsibility for payment may be demonstrated by—
- A judgment;
- A payment conditioned upon the beneficiary‘s compromise, waiver, or release (whether or not there is a determination or admission of liability) of payment for items or services included in a claim against the primary payer or the primary payer‘s insured; or
- By other means, including but not limited to a settlement, award, or contractual obligation.
We defer to this regulation if the statute it interprets is ambiguous or silent with respect to the specific issue, and if the Secretary‘s interpretation is a permissible construction of the statute. See Gulfcoast Med. Supply, Inc. v. Sec‘y, Dep‘t of HHS, 468 F.3d 1347, 1351 (11th Cir. 2006) (per curiam). As a general matter, “considerable weight should be accorded to an executive department‘s construction of a statutory scheme it is entrusted to administer....” Chevron U.S.A., Inc. v. Nat. Res. Def. Council, Inc., 467 U.S. 837, 844 (1984).
As we have noted, the relevant statutory language here is ambiguous. Both parties offer reasonable readings of the phrase “conditioned upon ... release.” And though
In our opinion,
The language of the statute bolsters this outcome. The statutory phrase “payment conditioned upon ... release” assumes that a payment may be revoked unless the “condition” of valid releases being provided has been satisfied. The statute does not use the language “payment in exchange for release” which would support a contrary argument that the releases must be effective prior to the payment. Nor does the statute express any dispositive aspect as to whom payment is made or whether payment must be released directly to beneficiaries—only that payment has been conditioned upon a release. Cf. 17A Corpus Juris Secundum, Contracts, § 451 (updated June 2013) (“A condition subsequent presumes a valid contract and refers to a future event.“). See also Settlement Agreement at ¶ 3(a) (“Each plaintiff ... as a condition of receiving any payment to or on behalf of such plaintiff ... shall be required to sign a general release of all claims“) (emphasis added).
Applying our interpretation of
In its briefs, the government essentially ignores
The government also argues that the cause of action could not have accrued before December 2, 2003—when the PCB plaintiffs’ lawyers certified that 97% of the PCB plaintiffs had signed releases—because the defendants did not know which plaintiffs would elect to settle their claims. We are not persuaded. First, this argument fails to materially advance the government‘s position; the government‘s lack of certainty does nothing to change our interpretation of the payment-conditioned-upon-release language in
The confirmation by the PCB plaintiffs’ lawyers that they had obtained 97% of releases was significant in a contractual sense because it ensured that the defendants would not be able to void the settlement agreement, but it did not give the government any more information about the existence of a claim under the MSPA than when those lawyers confirmed on October 28, 2003, that 75% of the releases had been obtained. The 97% certification was not a prerequisite for accrual of the government‘s MSPA claim; the significant event occurred when the PCB producers made a payment of $275 million to the PCB plaintiffs’ lawyers, conditioned upon releases by the PCB plaintiffs.
2
Additionally, the government‘s argument that our affirmance will require the filing of premature lawsuits is also undercut by another of the Secretary‘s regulations, which provides that the government “may initiate recovery as soon as it learns that payment has been made or could be made under workers’ compensation, any liability or no-fault insurance, or an employer group health plan.”
The import of these regulatory provisions,
The government‘s cause of action under the MSPA against the PCB producers, their insurers, and the PCB plaintiffs’ lawyers accrued on October 29, 2003, so the government had until October 29, 2009 to bring this lawsuit, even if the longer six-year statute of limitations applied pursuant to
III
The district court‘s dismissal of the government‘s complaint as untimely is affirmed.
AFFIRMED.
