Nat'l Comm. to Preserve Social Security and Medicare v. Philip Morris USA, Inc.

Plaintiffs brought action to recover costs of treating tobacco-related illnesses of Medicare beneficiaries under the Medicare Secondary Payer Act (MSP), claiming that defendants bore primary responsibility under MSP for costs advanced by Medicare.  The Court held that plaintiffs lacked standing because "MSP does not create a qui tam action" that would allow plaintiffs to recover. The Court remanded with instructions to dismiss the case. 

National Committee to Preserve Social Security and Medicare, et al. v. Philip Morris USA, Inc., et al., 395 Fed.Appx. 772 (2d Cir. 2010).

  • United States
  • Oct 8, 2010
  • United States Court of Appeals, Second Circuit
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Parties

Plaintiff

  • Medicare RIghts Center
  • National Committee to Preserve Social Security and Medicare
  • Sandra Emiller

Defendant

  • R.J. Reynolds Tobacco Co., individually and as successor by merger to Brown & Williamson USA, Inc.
  • Liggett Group, Inc.
  • Lorillard Tobacco Co.
  • Philip Morris USA, Inc.

Legislation Cited

Related Documents

Type of Litigation

Tobacco Control Topics

None

Substantive Issues

Type of Tobacco Product

None

"Plaintiffs argue that the MSP private action is a valid partial assignment of Medicare's right to be reimbursed by responsible primary payers, that the MSP is thus a qui tam statute within the historical mainstream of qui tam statutes, and consequently they have standing to assert Medicare's claim. Although their complaint alleged alternative grounds for standing based on an individualized injury suffered by a single Medicare beneficiary as well as by members of an association who are also Medicare beneficiaries, plaintiffs categorically disclaimed these grounds at a hearing before the district court on November 20, 2008..."The distinct language of the MSP strongly indicates that the MSP allows a private party not to bring suit on behalf of the Government to remedy any wrongs done thereto, but rather 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 payments required of it on behalf of the private party bringing the suit." Woods v. Empire Health Choice, Inc., 574 F.3d 92, 98 (2d Cir. 2009). Accordingly, the MSP "does not create a qui tam action, but rather merely enables a private party to bring an action to recover from a private insurer only where the private party has itself suffered an injury because a primary plan has failed to make a required payment to or on behalf of it." Id. at 101."