Opinion ID: 4562985
Heading Depth: 2
Heading Rank: 4

Heading: Liberty Claims

Text: As is relevant on appeal, MSPA presented two representative claims in its case against Liberty Mutual Fire Insurance Company (Liberty). These claims regarded medical expenses allegedly paid by Florida Healthcare Plus (FHCP) and the Interamerican Medical Center Group, LLC (IMC). In its third amended complaint, MSPA alleged that FHCP “made conditional payments” that should have been reimbursed by Liberty. Liberty D.E. 49 at 5. MSPA dropped its allegation that FHCP was an MAO, instead arguing that, “[i]n addition to MAOs, first-tier and downstream entities also suffer damages.” Id. at 21. On April 15, 2014, FHCP executed a contract with La Ley Recovery that conveyed to the latter FHCP’s right “to recover costs already paid” for beneficiaries from the appropriate primary payers. Liberty D.E. 49-8 at 2. In exchange, La Ley Recovery would provide FHCP with 50% of the claims collected. The term of the contract was for one year, with an automatic renewal for an additional year. The contract empowered La Ley Recovery to “assign the Agreement in whole or in part 12 Case: 18-12139 Date Filed: 09/04/2020 Page: 13 of 34 but the assignee must be approved by [FHCP].” Id. at 3. La Ley Recovery then assigned the rights it had acquired to MSPA. In its third amended complaint, MSPA alleged that FHCP approved the assignment. Liberty D.E. 49 at 11. On December 10, 2014, the Florida Department of Financial Services was appointed FHCP’s receiver. As FHCP’s receiver, the Department of Financial Services wrote to La Ley Recovery to cancel its contract and subsequently filed a petition to enjoin La Ley Recovery and MSPA from pursuing their recovery rights. After MSPA had filed the present litigation, however, the Department of Financial Services recognized the validity of FHCP’s contract with La Ley Recovery pursuant to a settlement agreement. MSPA also alleged that IMC, a management services organization, contracted with MAOs “to manage and provide healthcare services and absorb the risk of [financial] loss” for a defined population of beneficiaries. Liberty D.E. 58-2 at 3. IMC “irrevocably assign[ed] all of [its] rights” to seek double damages from primary payers to MSPRC, Liberty D.E. 49-14 at 9, which in turn assigned those rights to MSPA, id. at 2. In its third amended complaint, MSPA alleged that MSPRC’s assignment to MSPA was “ministerial in nature” and thus did not require IMC’s approval under the terms of IMC’s contract with MSPRC, id. at 12, and that, in any event, IMC “consented to any subsequent assignment from [MSPRC] to any thenexisting or future MSP Company, which include[d] MSPA,” Liberty D.E. 49 at 14. 13 Case: 18-12139 Date Filed: 09/04/2020 Page: 14 of 34 The district court (Kathleen M. Williams, J.) dismissed MSPA’s claims. The district court determined that MSPA’s claim derived from the FHCP assignment was legally deficient because the contract on which it was predicated was invalid at the time of filing, in the period between when the Department of Financial Services canceled FHCP’s assignment to La Ley Recovery and when the Department concluded the settlement agreement. MSPA Claims 1, LLC v. Liberty Mut. Fire Ins. Co., 322 F. Supp. 3d 1273, 1280–81 (S.D. Fla. 2018). The district court also found that the FHCP and IMC assignments were legally deficient because MSPA had failed to allege that FHCP and IMC consented to the assignments. Id. at 1280, 1282. Additionally, the district court concluded that, even if the assignments were valid, MSPA’s non-MAO assignors were categorically unable to access the Medicare Secondary Payer Act’s private right of action. Id. at 1283. Having allowed MSPA to amend its complaint numerous times, the district court entered its dismissal with prejudice.