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Medicare Advantage Organizations Dismissed From Avandia Claims

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Pennsylvania Eastern District Court judge Cynthia M. Rufe has dismissed all claims made against Avandia by Medicare Advantage Organization insurers who sought reimbursement for the insured who received treatment for Avandia related injuries and who have settled or will settle with Avandia maker GlaxoSmithKline.

The lawsuit claims that GSK has set aside $3.4 billion for settlements, and has already paid $460 million in nearly 10,000 cases. However, Judge Rufe rejected the case stating there is no private cause of action under the Medicare Advantage statute. Attorneys for Humana Medical Plan Inc., argued that the Medicare Secondary Payer Act entitled MAOs to these types of reimbursements.

Rufe wrote that “Humana is an MAO, and therefore is a party that the MA statute, including its secondary payer provision, was enacted to benefit.” She continued, “The MSP was enacted more than a decade prior to the MA statute, and yet Congress did not reference or explicitly incorporate the private right of action from the MSP when it wrote in the secondary payer provision of the MA act.”

The judge also said that Humana was not without recourse, “Rather than seeking payment directly from GSK under the Medicare Act, it can bring its claims in the state courts against its enrollees to enforce its secondary payer status under the terms of their insurance contracts.”

She explained that state courts “are well suited to interpret insurance contracts and determine whether the enrollees recovered medical damages against which Humana can seek reimbursement or assert subrogation rights under the terms of its enrollees’ contracts.” disclaimer: This article: Medicare Advantage Organizations Dismissed From Avandia Claims was posted on Wednesday, June 15th, 2011 at 7:29 pm at and is filed under Defective Drug Lawsuits.

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