United States District Court, S.D. Florida, Miami Division
MSPA CLAIM I, LLC, a Florida limited liability company, as assignee of Florida Healthcare Plus, on behalf of itself and all other similarly situated Medicare Advantage Organizations in the State of Florida, Plaintiff,
NATIONAL FIRE INSURANCE COMPANY OF HARTFORD, Defendant.
ORDER GRANTING MOTION TO DISMISS
FEDERICO K. MORENO, UNITED STATES DISTRICT JUDGE
case stems from the Medicare Secondary Payer Act's
private right of action, which allows Plaintiff, an assignee
of a Medicare Advantage Organization, to sue for
reimbursement of Medicare benefits provided to its enrollee,
who suffered burns at a location insured by Defendant
National Fire Insurance Company of Hartford. Defendant moved
to dismiss arguing the statutory threshold amount is not met.
This Court agrees the threshold amount is a prerequisite to
filing suit under the Act's private right of action.
Accordingly, the Court grants the motion to dismiss.
CAUSE came before the Court upon Defendant's Motion to
Dismiss (D.E. 46), I filed on February 6.
COURT has considered the motion, the response, pertinent
portions of the record, I and being otherwise fully advised
in the premises, it is
that the motion is GRANTED. It is also
that all other pending motions are DENIED as moot.
MSPA Claims I, LLC invokes the private cause of action
provision of the Medicare Secondary Payer Act to recover
reimbursement of Medicare benefits in this case. Plaintiff is
a twice-removed assignee of a Medicare Advantage
Organization, called Florida Healthcare Plus, Inc., which
paid medical bills incurred by its enrollee named L.H., who
suffered burns at a Sonic location. Plaintiff alleges
Defendant National Fire Insurance Company provided liability
insurance for Sonic and should reimburse the costs incurred
by Florida Healthcare Plus, Inc. Plaintiff also alleges that
National Fire settled L.H.'s claim against Sonic for $1,
500 on June 4, 2014, but National Fire failed to reimburse
Florida Healthcare Plus, Inc. for that amount.
Healthcare Plus, Inc. originally assigned its claim against
National Fire to La Ley Recovery Systems, Inc., which, in
turn, assigned its claim to Plaintiff MSPA Claims I, LLC.
Second Amended Complaint asserts two counts against National
Fire. The first is a private right of action under the
Medicare Secondary Payer Act, 42 U.S.C. §
1395y(b)(3)(A), seeking double damages for National
Fire's alleged failure to reimburse Florida Healthcare
Plus for Medicare benefits it advanced to cover L.H.'s
medical costs. The second count is for a declaratory judgment
as to National Fire's obligation to reimburse the payment
of conditional Medicare benefits.
National Fire is moving to dismiss arguing the settlement
amount of $1, 500 is I less than the threshold amount
necessary to trigger National Fire's reimbursement
obligation under the Medicare Secondary Payer Act. Second,
Defendant National Fire argues the assignment to Plaintiff is
invalid because the Medicare Advantage Organization, Florida
Healthcare Plus, Inc. did not approve it prior to the filing
of the complaint.
survive a motion to dismiss, plaintiffs must do more than
merely state legal conclusions, " instead plaintiffs
must "allege some specific factual basis for those
conclusions or face dismissal of their claims."
Jackson v. BellSouth Telecomm., 372 F.3d 1250, 1263
(11th Cir. 2004). When ruling on a motion to dismiss, a court
must view the complaint in the light most favorable to the
plaintiff and accept the plaintiffs well-pleaded facts as
true. See St. Joseph's Hosp., Inc. v. Hosp. Corp. of
Am., 795 F.2d 948, 953 (11th Cir. 1986). This tenet,
however, does not apply to legal conclusions. See
Ashcroft v. Iqbal, 129 S.Ct. 1937, 1949 (2009).
Moreover, "[w]hile legal conclusions can provide the
framework of a complaint, they must be supported by factual
allegations." Id. at 1950. Those
"[f]actual allegations must be enough to raise a right
to relief above the speculative level on the assumption that
all of the complaint's allegations are true."
Bell Ail. Corp. v. Twombly, 550 U.S. 544, 545
(2007). In short, the complaint must not merely allege a
misconduct, but must demonstrate that the pleader is entitled
to relief. See Iqbal, 129 S.Ct. at 1950.