Opinion ID: 4562985
Heading Depth: 2
Heading Rank: 1

Heading: ACE Claims

Text: As is relevant to this appeal, MSPRC presented two representative claims in its case for reimbursement against ACE American Insurance Company (ACE). These claims were for medical expenses that MSPRC alleged were directly charged to and paid by Hygea and Health Care Advisor Services, management services organizations that contract with MAOs to assist in providing healthcare and administrative services to beneficiaries. MSPRC’s third amended complaint alleged that these downstream actors, pursuant to their contracts with MAOs, “made conditional payments on behalf of [beneficiaries] to cover accident-related expenses” that should have been covered by ACE as the primary payer. ACE D.E. 36 at 2. The district court (Patricia A. Seitz, J.) dismissed MSPRC’s claims against ACE after concluding that non-MAO downstream actors, like Hygea and Health Care Advisor Services, cannot access the Medicare Secondary Payer Act’s private right of action that allows MAOs to seek double damages. MSP Recovery Claims, 8 Case: 18-12139 Date Filed: 09/04/2020 Page: 9 of 34 Series LLC v. ACE Am. Ins. Co., No. 17-cv-23749, 2018 WL 1547600, at  (S.D. Fla. Mar. 9, 2018). Having allowed MSPRC to amend its complaint numerous times, the district court entered its dismissal with prejudice.