• Humana Med. Plan, Inc. v. Reale
  • March 30, 2011 | Authors: Kathryn M. Almar; Arthur N. Lerner
  • Law Firm: Crowell & Moring LLP - Washington Office
  • The District Court for the Southern District of California rejected Humana's argument that the court had federal question jurisdiction over Humana's claim for the benefits paid to a beneficiary who had subsequently won damages in a slip-and-fall suit related to her injury.

    Humana, a Medicare Advantage organization, paid $19,155.41 to Reale in April 2009 for medical expenses to treat her injury from a fall.  Reale then filed a suit against the premises owner, who settled for an amount in excess of $19,155.41.  Humana sought to recover from Reale and her provider the benefits it had paid out under the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2).

    The court upheld the defendants' motion to dismiss after determining that Humana had been incorrect to interpret the Act and a related regulation as providing for a private right of action. Humana claimed it had, by regulation, the same authority to seek judicial remedies as the Secretary has under the Medicare statute.  However, according to the Court, Humana had misread the statute as authorizing the Secretary of the Department of Health and Human Services.  The court viewed the statute as authorizing only the United States, but not the Secretary, to bring such an action.