• Second Circuit Decides in Woods v. Empire Health Choice, Inc. that Medicare Secondary Payor Act Is Not a Qui Tam Statute -- Plaintiff Must Show Individual Injury
  • August 26, 2009 | Authors: Daly D. E. Temchine; Aime Dempsey
  • Law Firms: Epstein Becker & Green, P.C. - Washington Office ; Epstein Becker & Green, P.C. - New York Office
  • The United States Court of Appeals for the Second Circuit recently held that the Medicare Secondary Payer ("MSP") statute, which requires that payment for medical services for Medicare-eligible individuals must first be made from any available health insurance to the full extent of the coverage provided before Medicare funds are used, is not a qui tam statute. Woods v. Empire Health Choice, Inc., 07-4208-cv, - F.3d -, 2009 WL 2245216 (2d Cir., July 29, 2009) ("Woods"). The Woods decision benefits all health care insurers, health care providers, provider groups and self-insured employers who require Medicare to cover services that are subject to private coverage. The decision also is precedential in the Second Circuit. (The Second Circuit covers New York State, as well as Connecticut and Vermont.)