Double Damages or Nothing: Whether Medicare Advantage Organizations Have a Private Cause of Action Under the Medicare Secondary Payer Act

Authors

Jennifer A. Prevete

Document Type

Note

Abstract

(Excerpt)

Part I of this Note outlines the history and purpose of the Medicare statute, Medicare Advantage, and the MSP Act. The MSP Act dictates that insured individuals pursue coverage from “primary plans” while Medicare makes conditional payments with the agreement that the primary plans will reimburse the costs. Part II provides the MSP Act’s spectrum of interpretations and why the United States Circuit Courts of Appeals have read the private cause of action with varying expansiveness. Part III concludes that the private cause of action should not be extended to MAOs, asserting that the extension ultimately results in harm to the injured insured and inefficiency in mass tort litigation and settlement. Despite the worthy goal of reducing the cost of healthcare coverage, providing private insurers with a new federal remedy and entitlement to double damages is an undesirable and inefficient solution.