Bio-Medical Applications of Tennessee, Inc. v. Central States Southeast & Southwest Areas Health & Welfare Fund (2011)
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But see Bio-Medical , 656 F.3d at 280 (noting that Medicare paid Bio-Medical an amount that was less than what it would have received from defendant, the primary payer); Duncan v. Liberty Mutual Insurance Company , 745 Fed.Appx. 575 , 576 (6th Cir. 2018) (involving "Medicare's payment of [plaintiff]'s medical expenses for his injuries from an automobile crash."); Gucwa v. Lawley , 731 F. App'x 408 , 411, 414 (6th Cir. 2018) (alleging that Medicare paid plaintiff's treatment …
noting that Medicare paid Bio-Medical an amount that was less than what it would have received from defendant, the primary payer
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DaVita, Inc. v. Marietta Mem. Hosp. (2020)
Areas Health & Welfare Fund, 656 F.3d 277, 281 (6th Cir. 2011).
The district court granted State Farm’s motion, 2 holding that Michigan Spine’s claim was foreclosed by Bio-Medical Applications of Tennessee, Inc. v. Central States Southeast & Southwest Areas Health & Welfare Fund, 656 F.3d 277, 285 (6th Cir.2011), which stated that a private party can recover under the Medicare Secondary Payer Act only if a “primary plan” has failed to provide appropriate reimbursement “in accordance with paragraphs (1) and (2)(A).” Because the Bio-Medica…
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Lynette Duncan v. Liberty Mutual Ins. Co. (2021)
Areas Health & Welfare Fund, 656 F.3d 277, 281 (6th Cir. 2011).
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Carra Penegar v. Liberty Mutual Insurance Company (2024)
Areas Health and Welfare Fund, 656 F.3d 277, 285 (6th Cir. 2011) (“Paragraph (1) . . . essentially lays out a system of rules instructing when group health plans must pay for medical items and services. . . .
“Paragraph (1) . . . essentially lays out a system of rules instructing when group health plans must pay for medical items and services. . . . Paragraph (2) . . . instructs when Medicare may or may not pay for medical items and services.”
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Davita Inc. v. Virginia Mason Memorial (2020)
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011).
Directv, Inc. v. Treesh , 487 F.3d 471 , 476 (6th Cir. 2007). 3 This court has previously explained the private cause of action in straightforward terms: "a primary plan is liable under the private cause of action when it discriminates against planholders on the basis of their Medicare eligibility and therefore causes Medicare to step in and (temporarily) foot the bill." Bio-Medical , 656 F.3d at 286 (explaining how primary plans fail to pay in accordance with "paragraphs (1…
explaining how primary plans fail to pay in accordance with "paragraphs (1) and (2)(A)"
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011).
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Guillermina Parra v. Pacificare of Arizona, Inc. (2013)
Areas Health & Welfare Fund, 656 F.3d 277, 279 (6th Cir. 2011), cert. dismissed, 132 S. Ct. 1087 (2012) (noting that the private cause of action provides an “incentive for healthcare providers to bring lawsuits to vindicate Medicare’s interests”); Woods v. Empire Health Choice, Inc., 574 F.3d 92, 98 (2d Cir. 2009) (“[T]he MSP allows a private party . . . to bring suit in the party’s own name to remedy the wrong done to it – namely the failure of a primary plan to make the pa…
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Hadden v. United States (2011)
The "demonstrated responsibility" clause was recently discussed in this Court's opinion in Bio-Medical Applications of Tennessee, Inc. v. Central States Southeast & Southwest Areas Health & Welfare Fund, 656 F.3d 277, 289-90 (6th Cir.2011), which explained that the clause was added in response to the federal courts' rejection of the Secretary's attempts to collect from tortfeasors under section 1395y(b)(2)(B)(ii) and (iii).
States Se. & Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011).
Ar- eas Health and Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011) (“Before the [MSP] Act, Medicare paid for all medical treatment 1 United Auto moved for summary judgment on several grounds and the dis- trict court decided only one.
Ar- eas Health and Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011) (“Before the [MSP] Act, Medicare paid for all medical treatment 1 United Auto moved for summary judgment on several grounds and the dis- trict court decided only one.
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Aetna Life Insurance Company v. Big Y Foods, Inc. (2022)
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011).
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River City Fraternal Order v. Ky. Ret. Sys. (2021)
Areas Health & Welfare Fund, 656 F.3d 277, 282 (6th Cir. 2011).
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Netro v. Greater Balt. Med. Ctr., Inc. (2018)
Areas Health & Welfare Fund, 656 F.3d 277, 279 (6th Cir. 2011).
Areas *314 Health & Welfare Fund, 656 F.3d 277, 289-90 (6th Cir.2011) (explaining Congress’s intent to foreclose litigation on the definition of “primary plan” via the 2008 amendments).
Areas Health & Welfare Fund, 656 F.3d 277, 284-87 (6th Cir.2011). 2 .
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United States v. James Stricker (2013)
Areas Health and Welfare Fund, 656 F.3d 277, 291 (6th Cir.2011) (concluding that “other means” language in § 1395y(b)(2)(B)(ii) is ambiguous and according Chevron deference to 42 C.F.R. § 411.22 (b)(3) as a reasonable regulation); Mason v. Sebelius, No. 11-2370 (JBS/KMW), 2012 WL 1019131 , at *14 (D.N.J.
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Guadalupe Caldera v. Ins Co. of the State of PA (2013)
Areas Health & Welfare Fund, 656 F.3d 277, 279, 286 (6th Cir.2011), cert. dismissed, - U.S. -, 132 S.Ct. 1087 , 181 L.Ed.2d 805 (2012) (concluding that "a primary plan is liable under the private cause of action when it discriminates against plan-holders on the basis of their Medicare eligibility and therefore causes Medicare to step in and (temporarily) foot the bill” (emphasis added)). 7 .
These reasons include, inter alia, that the demonstrated responsibility provision's "text places a condition only on when primary plans must reimburse Medicare; it does not mention when plans must pay private parties,” that “the structure of the Act suggests that the provision is limited to the reimbursement of Medicare,” and that "the predominant legislative backdrop was Medicare's (not private parties’) failed attempts to bring lawsuits against tortfeasors.” Bio-Medical Ap…
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011).
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011)).
Before 1980, “Medicare paid for all medical treatment within its scope and left private insurers merely to pick up whatever expenses remained.” Bio-Medical Applications of Tenn, Inc v Central States Southeast & Southwest Areas Health & Welfare Fund, 656 F3d 277, 278 (CA 6, 2011).
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011).
Areas Health & Welfare Fund, 656 F.3d 277, 281 (6th Cir. 2011); see 42 C.F.R. § 411.162 (a) (2019).
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Collins v. Wellcare Healthcare Plans, Inc. (2014)
Areas Health and Welfare Fund, 656 F.3d 277, 286 (6th Cir.2011)).
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Alpha Thirteen, LLC v. Geico Casualty Company, Progressive Preferred Insurance Company, and Amberly Montanez (2026)
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011). when it enacted the MSP Act, which made Medicare the secondary payer in an attempt to control Medicare’s rising costs.21 Two years later, Congress further amended the Medicare statute by creating a “private cause of action” to recover double damages if a primary insurer “fails to provide for primary payment (or appropriate reimbursement) in accordance with paragraphs (1) and (2)(A).”22 Paragraph (1) of that prov…
Areas Health & Welfare Fund, 656 F.3d 277, 281 (6th Cir. 2011).
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011).
Areas Health & Welfare Fund, 656 F.3d 277, 281 (6th Cir. 2011), making Medicare a secondary payer and prohibiting it from making a payment if “payment has been made or can reasonably be expected to be made” by a primary payer. 42 U.S.C. § 1395y(b)(2)(A)(ii).
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011)).
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011)).
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United States of America v. Allstate Insurance Co (2022)
States Se. & Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011).
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011).
Areas Health & Welfare Fund, 656 F.3d 277, 281 (6th Cir. 2011).
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Cooper Hospital University Medical Center v. Selective Insurance Company of America (085211) (Camden County a… (2021)
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011) (stating that before 1980, “Medicare paid for all medical treatment within its scope and left private insurers merely to pick up whatever expenses remained”).
stating that before 1980, “Medicare paid for all medical treatment within its scope and left private insurers merely to pick up whatever expenses remained”
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011)).
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Sexton v. Medicare (2016)
Areas Health & Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011) (same).
same
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Hope v. Fair Acres Geriatric Center (2016)
Areas Health & Welfare Fund, 656 F.3d 277, 293 (6th Cir.2011) (stating-that “the ‘demonstrated responsibility’ provision places a condition that must be fulfilled only before primary plans (specifically, tortfeasors) must reimburse Medicare”).
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Estate v. Recoveryet Al. (2014)
Areas Health & Welfare Fund, 656 F.3d 277, 290-91 (6th Cir. 2011) (“[T]he text of [§ 1395y(b)(2)(A)] is addressed to all ‘primary plans’—the Act’s broadest category of private insurer, . . . which includes ‘self-insured plans,’ and therefore (after the 2003 amendments) tortfeasors . . . .”); Rick Swedloff, Can’t Settle, Can’t Sue: How Congress Stole Tort Remedies from Medicare Beneficiaries, 41 Akron L.
“[T]he text of [§ 1395y(b)(2)(A)] is addressed to all ‘primary plans’—the Act’s broadest category of private insurer, . . . which includes ‘self-insured plans,’ and therefore (after the 2003 amendments) tortfeasors . . . .”
Areas Health & Welfare Fund, 656 F.3d 277, 290-91 (6th Cir.2011) ("[Tlhe text of [§ 1395y(b)(2)(A) ] is addressed to all 'primary plans’ — the Act’s broadest category of private insurer, ... which includes 'self-insured plans,’ and therefore (after the 2003 amendments) tortfeasors____”); Rick Swedloff, Can’t Settle, Can’t Sue: How Congress Stole Tort Remedies from Medicare Beneficiaries, 41 Akron L.Rev. 557, 583-85 (2008) (discussing the 2003 amendments). .
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Plante v. Dake (2015)
Compare Glover v. Liggett Grp., Inc., 459 F.3d 1304, 1309 (11th Cir.2006) (holding that "an alleged tortfeasor’s responsibility for payment of a Medicare beneficiary's medical costs must be demonstrated before an MSP private cause of action for failure to reimburse Medicare can correctly be brought under section 1395y (b)(3)(A), ’ ’ because § 1395y(b)(2)(B)(ii)’s "demonstrated responsibility” provision creates a condition precedent), with Bio-Medical Applications of Tennesse…
See also Mich Spine & Brain Surgeons, PLLC v State Farm Mut Auto Ins Co, 758 F3d 787, 790 (CA 6, 2014).1 Under the MSPA, if a primary plan “fails to pay for treatment, Medicare may make a conditional payment for the treatment.” Bio-Med Applications of Tenn, Inc v Central States Southeast & Southwest Areas Health & Welfare Fund, 656 F3d 277, 286 (CA 6, 2011).
See Bio-Medical, 656 F.3d at 285 .
See Bio-Medical, 656 F.3d at 285 .