Medicare Secondary Payer - No Qui Tam Action
In the face of Section 111 and the industry's effort to comply with same, some good news for a change!
On July 29, 2009, the Second Circuit ruled that the Medicare Secondary Payer Statue does not permit a private individual to file a qui tam action on behalf of the federal government. In this case, the plaintiff tried to file suit against an insurance company alleging that the company had failed to meet its obligations to ensure that it, and not the Medicare program, paid for certain claims for medical care from its insureds or others it was obligated to cover. See Woods v. Empire Health Choice, Inc. No. 07-4208-cv (2d Cir. July 29, 2009).
While this is a great result for health care insurers and self-insured providers who have more than enough to worry about right now, it is also a good reminder of something to be mindful of as more and more individuals are becoming aware of the new lottery game that is the qui tam lawsuit. For those outside the jurisdiction of the Second Circuit, remember that this decision is something to hope for but not binding on your federal courts. Good faith efforts to comply with the MSP (and Section 111) reporting obligations is very important both in the context of your interaction with the Medicare program but also in your interaction with your employees and other individuals who may be watching and questioning your conduct and your commitment to do what is right.
