Medicare Advantage Plan’s Double Damages Claims Limited by District Court for Connecticut
If you have worked with Precision Resolution in the past or have been to any of our lectures, then you know that it has always been our position that Medicare Advantage plans have no rights of recovery against a plaintiff's settlement proceeds. The case, Aetna Life Ins. Co. v. Guerrera 2018 U.S. Dist. LEXIS 41450 from the District of Connecticut partially confirms that, and disallows the use of the double damages provision of the Medicare Secondary Payer Act's Private Cause of Action against plaintiffs and plaintiff's attorneys.
The facts of this case are like many others: Plaintiff Guerrera was injured at a Big Y grocery store. Ms. Guerrera's medical expenses were paid for by Aetna, a Medicare Advantage Plan. Aetna notified Ms. Guerrera, her counsel, as well as Big Y, of its reimbursement rights in the amount of $9,854.16. Ms. Guerrera then settled her claim against Big Y in the amount of $30,000.00, and Big Y tendered the settlement proceeds to her counsel.
Aetna was not reimbursed, and it brought suit against Guerrera, her attorneys, and against Big Y (a self-insured entity), for double damages through the MSP's Private Cause of Action provision.