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Saturday, January 19, 2013

Beneficiary Not Permitted Injunctive Relief From EIRSA Plan Invoking MSP Terms

A Federal Court held that a beneficiary was unable to seek injunctive relief against an EIRSA plan, where the beneficiary sought to have the ERISA Plan action to declare Medicare the primary plan and subject to the Medicare Secondary Payer Act (MSP). The ERISA plan was held to have the right to changes the terms of the plan in order to align the UNICare Benefits of Choice Program with federal law.

The court declared the MSP action alleged in the complaint moot as it granted the motion to dismiss on the injunctive relief issue. The plaintiff/beneficiary sought to allege a private cause of action for double damages against "those of any entity contractually obliged to pay for an individual’s primary health care" The Court held, "....the plaintiff is not attempting to collect damages for medical bills improperly paid by Medicare on his behalf, but instead seeks an injunction requiring Unilever to pay for future medical expenses. No court has allowed a claim for injunctive relief under § 1395y(b)(3)(A) and I am persuaded that such a claim is not authorized by the statute." Im a footnote the indicated, "The government may be authorized to seek declaratory and injunctive relief under § 1395y (b)(2)(B)(iii)See United States v. Baxter Int'l, Inc., 345 F.3d 866, 909 (11th Cir.2003)."

PACHALY v. BENEFITS ADMINISTRATION COMMITTEE UNILEVER UNITED STATES INC. et al., 2913 WK 172993 (DC CT 2013) Decided Jan. 16, 2013