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

Heading: Auto-Owners Claims

Text: MSPRC presented five representative claims for reimbursement in its case against Auto-Owners Insurance Company, Southern-Owners Insurance Company, and Owners Insurance Company (collectively, Auto-Owners). These claims were for medical expenses allegedly paid by Health First Administrative Plans, Inc. (HFAP) and Verimed IPA, LLC (Verimed). MSPRC alleged that HFAP is an MAO, even though Health First Health Plans, Inc. (Health First), a related company that is not HFAP, contracted directly with Medicare to be a part of the Medicare Advantage system. In support of its allegation, MSPRC submitted an affidavit from Michael Keeler, the Chief Operating Officer of both HFAP and Health First. The Keeler affidavit explained that “HFAP had and continues to have authority to manage and act on behalf of Health First Health Plan, Inc. with respect to all financial assets, including the Assigned Claims.” Auto-Owners D.E. 60-1 at 1. It further explained that “HFAP, on behalf of Health First Health Plans, Inc., entered into a Recovery Agreement . . . whereby HFAP assigned to MSP Recovery all right, title, interest in and ownership of the Assigned Claims.” Id. The affidavit included an agreement between HFAP and Health First, 9 Case: 18-12139 Date Filed: 09/04/2020 Page: 10 of 34 which shows that the two companies have the same parent company, that HFAP “shall act as the general, administrative and financial manager” of Health First, that HFAP shall engage in “oversight with respect to the management of the assets of” Health First, that HFAP has the authority to deposit Health First funds and make payments on behalf of Health First, and that HFAP shall provide Health First with “[c]onsultation and assistance with . . . legal affairs” and with “risk management and compliance” services, as reasonably required. Id. at 4–5. Verimed is an independent physician association that serves as an intermediary between an MAO and medical service providers. MSPRC alleged that Verimed, under its contract with its MAO, “is required to completely pay for whatever accident-related medical expenses are incurred” by a beneficiary. Auto-Owners D.E. 48 at 11. As described, Verimed reimbursed its MAO for conditional payments. Id. at 22 (“[The MAO] paid $155.68 for the accident-related expenses and, pursuant to their arrangement, required Verimed to fully reimburse and pay for those medical expenses.”). The district court (Patricia A. Seitz, J.) dismissed MSPRC’s claims against Auto-Owners after determining that HFAP was not an MAO, that MSPRC did not hold any assignments from an MAO, and that non-MAOs like HFAP and Verimed cannot access or assign a claim under the Medicare Secondary Payer Act’s private right of action. MSP Recovery Claims, Series LLC v. Auto-Owners Ins. Co., Nos. 10 Case: 18-12139 Date Filed: 09/04/2020 Page: 11 of 34 17-cv-23841, 17-cv-24069, 17-cv-24066, & 17-cv-24068, 2018 WL 1953861, at  (S.D. Fla. Apr. 25, 2018). Having allowed MSPRC to amend its complaint numerous times, the district court entered its dismissal with prejudice.