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Eleventh Circuit rules that Medicare Advantage Organization was not bound by claims-filing provision in Medicare Secondary Payor Act and was not subject to 3-year statute of limitations in lawsuit seeking reimbursement from at-fault driver’s insurance company for conditional payments made on behalf of insured

On February 13, 2020, in MSPA Claims 1, LLC v. Kingsway Amigo Insurance Company, No. 18-14980, the Eleventh Circuit Court of Appeals reversed a district court ruling dismissing the lawsuit of a Medicare Advantage Organizations (MAO) because it had not been filed within 3 years of notification of the at-fault driver’s insurance company’s responsibility for damages suffered by the MAO’s insured in a motor vehicle accident. Although the Medicare Secondary Payor Act, 42 U.S.C. § 1395y, contains a provision that can be construed to require the government to sue within three years of the date that Medicare receives notice of a primary payer’s responsibility to pay, the Eleventh Circuit concluded that even if this provision is considered to apply to MAOs (which the Court questioned but did not resolve) it is not actually a statute of limitations barring a lawsuit filed after more than three years. Instead, the Court concluded that the provision simply allows Medicare to overcome any time limits prescribed by an employer’s group health plan that might otherwise prevent it from requesting reimbursement within the three-year period.