MSPA Claims 1, LLC v. Covington Specialty Insurance Company

Summary

The Eleventh Circuit held that the Medicare Secondary Payer Act does not preempt either a contractual one-year claims-filing deadline in a no-fault or general liability insurance policy or Florida’s statutory pre-suit demand requirement under Fla. Stat. § 627.736(10)(a). The court reasoned that the Act’s three-year filing provision applies only to the United States and to employer group health plans, not to private insurers, and that the Florida notice-and-cure requirement does not obstruct the Act’s purpose of shifting primary-payer responsibility to private insurers. The decision affirms summary judgment for the insurers, with a partial dissent arguing that Florida’s pre-suit demand impermissibly shifts the burden back to Medicare and is therefore conflict-preempted.

Holdings

1. The Act does not preempt the deadline because the provision cited (42 U.S.C. § 1395y(b)(2)(B)(vi)) applies only to the United States and to employer group health plans, not to no-fault or general liability policies.
2. The Act does not preempt the requirement because it does not conflict with the Act's purpose; it is a procedural requirement that does not create an unconstitutional obstacle.
3. MSPA forfeited this claim by failing to allege it in the complaint.

Questions Presented

1. Whether the Medicare Secondary Payer Act preempts the contractual claims-filing deadline in Covington's insurance policy
2. Whether the Medicare Secondary Payer Act preempts Florida's statutory pre-suit demand requirement under Fla. Stat. § 627.736(10)(a)
3. Whether MSPA forfeited its claim that Covington's settlement with the beneficiary established primary-payer status

Disposition

affirmed