Medicare Secondary Payer Statute

Tort Litigation and the Medicare Secondary Payer Statute
Glover v. Philip Morris
No. 05-14219
United States Court of Appeals for the Eleventh Circuit

Urging the Eleventh Circuit to reject the plaintiff's novel reading of the federal Medicare Secondary Payer statute ("MSP") to include actions for double damages against defendants for unadjudicated claims for medical expenses, NCLC argues that Congress did not intend that double damages actions be used for reimbursement where the underlying claim had not been resolved.  The MSP statute requires reimbursement to the federal government for medical expenses paid where an organization's own health plan is responsible for the costs and provides a right of private action to collect the reimbursement.

Amicus brief filed 11/09/05.

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Defendants Not Responsible for Unadjudicated Claims for Medical Expenses  
Glover v. Philip Morris
No. 05-14219
United States Court of Appeals for the Eleventh Circuit

On August 14, 2006, the Eleventh Circuit ruled in Glover v. Liggett Group, Inc. that the Medicare Secondary Payer statute ("MSP") does not convert garden variety state tort litigation into matters of federal concern. The MSP statute requires reimbursement to the federal government for medical expenses paid where an organization's own health plan is responsible for the costs and provides a right of private action to collect the reimbursement. In this case, the plaintiffs filed a lawsuit against Philip Morris and Liggett Group, arguing that the defendants were required to reimburse Medicare for health care costs that they had allegedly caused by selling tobacco products and, because they had not done so, the defendants should be forced to pay double damages. Urging the court to reject the plaintiff's novel reading of the statute to include actions for double damages against defendants for unadjudicated claims for medical expenses, NCLC argued in its amicus curiae brief that Congress did not intend that double damages actions be used for reimbursement where the underlying claim had not been resolved. 

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Improper Use of Medicare Secondary Payer Statute Against Employers
Telecare Corporation v. Leavitt
No. 05-263
U. S. Supreme Court (Certiorari)
 
NCLC urges the Supreme Court to grant review and reverse the Federal Circuit in this case involving the Medicare Secondary Payer ("MSP") statute. Under that statute, a private group health plan (as a primary insurer) must first pay any covered medical expense; Medicare will only reimburse uncovered eligible expenses.  When Medicare erroneously pays health care expenses that are the responsibility of a primary health plan, its reimbursement rights are governed by the MSP statute.  This case involves a challenge to the government's growing practice of seeking such reimbursement from plan-sponsoring employers who have no obligation to pay those health care expenses, but have instead contracted with a third-party insurer to cover those expenses.  The Federal Circuit concluded that the government's practice is authorized by the Medicare Secondary Payee (MSP) statute. NCLC contends that Medicare is not authorized to obtain reimbursement from employers who are only a plan sponsor because such employers are not "required or responsible" to cover health care expenses for purposes of the MSP statute; their only obligation is to pay the insurance premiums they owe to the plan's third-party insurer. 
 
Amicus brief filed 9/28/05.

 

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