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LLC v. Halifax Health, Inc.

United States District Court, M.D. Florida, Orlando Division

July 18, 2018

MSPA CLAIMS 1, LLC, Plaintiff,
v.
HALIFAX HEALTH, INC, Defendant.

          ORDER

          GREGORY A. PRESNELL UNITED STATES DISTRICT JUDGE

         This matter comes before the Court without a hearing on the Motion for Reconsideration (Doc. 82) filed by the Plaintiff, MSPA Claims 1, LLC (henceforth, “MSPA”), and the response in opposition (Doc. 96) filed by the Defendant, Halifax Health, Inc. (“Halifax”). MSPA seeks reconsideration of this Court's order of March 2, 2018 (Doc. 75) dismissing, with prejudice, its double-damages claim against Halifax under 42 U.S.C. § 1395y(b)(3)(A). MSPA is asserting the claim as the assignee of Florida Healthcare Plus, Inc. (“FHPI”), which is alleged to have overpaid Halifax by $10, 000. The claim was dismissed on the grounds that the statute only authorizes such claims against primary insurers rather than health care providers such as Halifax.

         I. Legal Standard

         A. Motions for Reconsideration

         While the federal rules do not specifically provide for the filing of a “motion for reconsideration, ” Van Skiver v. United States, 952 F.2d 1241, 1243 (10th Cir. 1991), cert. denied, 506 U.S. 828, 113 S.Ct. 89, 121 L.Ed.2d 51 (1992), it is widely known that Rule 59(e) encompasses motions for reconsideration. 11 Charles Alan Wright, Arthur R. Miller, and Mary Kay Kane, Federal Practice and Procedure 2d § 2810.1 (2007). However, due to the need to conserve scarce judicial resources and in the interest of finality, reconsideration is an extraordinary remedy that is to be employed sparingly. U.S. v. Bailey, 288 F.Supp.2d 1261, 1267 (M.D. Fla. 2003). The decision on whether to alter or amend a judgement is committed to the sound discretion of the district court. O'Neal v. Kennamer, 958 F.2d 1044, 1047 (11th Cir. 1992).

         The authorities generally recognize four basic grounds upon which Rule 59(e) motion may be granted:

First, the movant may demonstrate that the motion is necessary to correct manifest errors of law or fact upon which the judgment is based. Second, the motion may be granted so that the moving party may present newly discovered or previously unavailable evidence. Third, the motion will be granted if necessary to prevent manifest injustice. Serious misconduct of counsel may justify relief under this theory. Fourth, a Rule 59(e) motion may be justified by an intervening change in controlling law.

         Charles Alan Wright, Arthur R. Miller, and Mary Kay Kane, Federal Practice & Procedure 2d § 2810.1 (2007).

         Importantly, parties may not use a Rule 59(e) motion to relitigate old matters, Michael Linet, Inc. v. Village of Wellington, Fla., 408 F.3d 757, 763 (11th Cir. 2005), or to raise new legal arguments which could and should have been made during the pendency of the underlying motion, Sanderlin v. Seminole Tribe of Florida, 243 F.3d 1282, 1292 (11th Cir. 2001). To avoid repetitive arguments on issues already considered fully by the court, rules governing reargument are narrowly construed and strictly applied. St. Paul Fire & Marine Ins. Co. v. Heath Fielding Ins. Broking Ltd., 976 F.Supp 198 (S.D.N.Y. 1996).

         B. Medicare Advantage Organizations and Secondary Payers

         As originally constituted, Medicare paid for all medical treatment within its scope and left private insurers to pick up whatever expenses remained. See Humana Medical Plan, Inc. v. Western Heritage Insurance Company, 832 F.3d 1229, 1234 (11th Cir. 2016). In 1980, in an effort to curb the rising costs of Medicare, Congress enacted the MSP Act, 42 U.S.C. § 1395y(b) [the “MSP”], which made other insurers covering the same treatment the primary payers and Medicare the secondary payer. Id. To accomplish this, 42 U.S.C. § 1395y(b)(2)(A) forbids Medicare from making payments - with one exception - for any item or service when payment has been made (or can reasonably be expected to be made) by another form of insurance, such as a group health plan, worker's compensation law, or automobile insurance. These other forms of insurance are referred to as “primary plans.” 42 U.S.C. § 1395y(b)(2)(A).

         The one exception is found in 42 U.S.C. § 1395y(b)(2)(B), which authorizes Medicare to make a “conditional payment” if a primary plan “has not made or cannot reasonably be expected to make payment with respect to such item or service promptly”. Any such payments are “conditioned on reimbursement” to Medicare. 42 U.S.C. § 1395y(b)(2)(B)(i). A primary plan - and an entity that receives payment from a primary plan - must reimburse Medicare for any conditional payment “if it is demonstrated that such primary plan has or had a responsibility to make payment with respect to such item or service.” 42 U.S.C. § 1395y(b)(2)(B)(i).

To facilitate recovery of conditional payments, the MSP provides for a government action against any entity that was responsible for payment under a primary plan, 42 U.S.C. § 1395y(b)(2)(B)(iii), and subrogates the United States to the rights of a Medicare beneficiary to collect payment under a primary plan for items already paid by Medicare, § 1395y(b)(2)(B)(iv). The MSP also creates a private right of action with double recovery to encourage private parties who ...

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