July 06, 2012
Medicare Advantage provider Humana Medical Plan Inc. is allowed under Medicare law to seek reimbursement from GlaxoSmithKline PLC (GSK) for the costs of treating insurance customers who were injured by GSK’s Avandia diabetes drug, a unanimous Third Circuit U.S. Court of Appeals panel said yesterday (In Re: Avandia Marketing, Sales Practices and Products Liability Litigation, No. 11-2664 (3rd Cir. Jun. 28, 2012).
In a unanimous opinion, the Third Circuit panel said that the Medicare Secondary Payer Act does provide Humana with a private cause of action against GSK. “Even if we were to find, as Appellees suggest, that this provision is ambiguous, we would nonetheless be required to defer to regulations issued by the Centers for Medicare and Medicaid Services (‘CMS’),” the panel wrote.
“The language of the MSP private cause of action is broad and unrestricted and therefore allows any private plaintiff with standing to bring an action,” the panel wrote. “Since private health plans delivered Medicare services prior to the 1980 passage of the MSP Act, Congress was certainly aware that private health plans might be interested private parties when it drafted the cause of action, and it did not exclude them from that provision’s ambit.”
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