In Humana v. Paris Blank, LLP et al 2016 U.S. Dist. LEXIS 61814, Paris Blank, LLP, a plaintiff law firm, was sued by Humana Medicare Advantage for failing to reimburse Humana for conditional payments.  This is the first time an MSP Private Cause of Action has been filed against a plaintiff attorney or firm.  Paris Blank filed a motion to dismiss, which was denied by the Court on May 10, 2016.

The plaintiff, Humana Medicare Advantage, alleges that they paid nearly $200,000 in conditional payments on behalf of an injured party who was represented by Paris Blank, LLP.  Despite Paris Blank, the defendant, securing settlements in excess of $450,000 for the injured party, and receiving settlement checks from the insurance companies including Humana as a payee, the defendant deposited the checks without considering Humana.  Humana had previously communicated to the injured party the total of the conditional payments it was owed, and Paris Blank had submitted a waiver request to Humana on the injured party’s behalf.

After hearing numerous arguments from Plaintiff and Defendant, the Court agreed with the Plaintiff and found that the MSP law does not create exceptions for attorneys and law firms.  The Court found that the language of the MSP statute in question “is broad and unambiguous, placing no limitations upon which private (i.e., non-governmental) actors can bring suit for double damages when a primary plan fails to reimburse any secondary payer.”

This decision is not final, but regardless of what the Court ultimately decides, plaintiff law firms should take heed and ensure that their lien resolution process, whether internal or outsourced, addresses any potential Medicare Advantage liens prior to final settlement disbursement.

Download the Humana Complaint here

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