Action seeking medical benefits, declaratory relief, & double damages under the Medicare Secondary Payer Act (MSPA); 42 USC § 1395y(b)(3)(A); Michigan Spine & Brain Surgeons, PLLC v State Farm Mut Auto Ins Co (6th Cir); § 1395y(b)(2)(A)(ii); Jarrad v Integon Nat'l Ins Co; Conditional Medicare payment; Bio-Med Applications of TN, Inc v Central States SE & SW Areas Health & Welfare Fund (6th Cir); Principle that a primary insurer must have knowledge that they owed a primary payment before a party can claim double damages under the MSPA; MSP Recovery Claims, Series LLC v ACE Am Ins Co (11th Cir)

The court held that the trial court did not err by dismissing plaintiff-healthcare provider’s claims in favor of defendant-insurer. Plaintiff sued for no-fault medical benefits, declaratory relief, and double damages under the MSPA, related to healthcare services it provided to DV, who was injured in a car accident. The trial court dismissed plaintiff’s claims. On appeal, the court found defendant “never denied coverage or payment. Instead, it appears that defendant intended to pay the bill in June 2022, but a system error resulted in the delay of payment. Plaintiffs then sued defendant, and this resulted in defendant learning that plaintiffs had billed” DV’s Medicare Advantage plan (Aetna), “and Aetna had paid. This information plausibly led defendant to question whether Aetna was a Medicare payer.” In addition, the “MSPA contains no language specifically providing for how long a primary plan has to pay a bill before it will be determined that the primary plan has ‘failed’ to pay, but plaintiffs sued defendant only three weeks after defendant received the bill. And, at that point, defendant intended to pay.” The court agreed with defendant that it “could not have reasonably been expected to pay the bill before it knew about the bill. Defendant has now made full payment to plaintiffs.” The court held that the trial court “did not err by finding that double damages were not warranted.” Affirmed.