No-fault insurer prevails in attempted class action over Medicare reimbursement
A state appeals court has rejected a class action filed by a Medicare Advantage organization seeking double reimbursements for its costs of providing care that should have been covered by a no-fault auto insurer.
In a unanimous ruling, the 3rd District Court of Appeal said such organizations would have to establish each claim separately against Ocean Harbor Casualty Insurance.
The court overruled Miami-Dade Circuit Judge Samantha Ruiz-Cohen, who had certified a class potentially including 37 Florida Medicare Advantage organizations, or MROs.
The lead plaintiff was an entity called MSPA, an assignee of the defunct MRO Florida Healthcare Plus Inc.
“Proof that certain medical bills paid by MSPA’s alleged assignor should have been paid by Ocean Harbor as a primary payer will not establish that other medical bills paid by a different MAO should also have been paid by Ocean Harbor as a primary payer,” Judge Thomas Logue wrote.
“To the contrary, proof to establish liability will necessarily devolve into a series of mini-trials under Florida no-fault law … which precludes a finding of predominance and renders this case inappropriate for class action treatment,” Logue wrote.
“Accordingly, we reverse the provisions of