Paula Meador (“Ms. Meador”) received treatment from Dr. Kim Houde (“Dr. Houde”), an employee of the United States, for her bipolar disorder. Dr. Houde prescribed lithium carbonate to treat Ms. Meador. After falling unconscious, Ms. Meador was diagnosed with acute lithium toxicity due to the elevated levels of lithium in her blood. Ms. Meador never recovered and died on June 15, 2019.
Plaintiffs Kenneth Meador and Thomas Meador (the “Meadors”) filed their federal lawsuit against Defendant the United States of America (the “U.S.”) alleging wrongful death and loss of consortium. Ms. Meador had received Medicare benefits through United’s AARP Medicare Advantage Plan. As a Medicare Advantage Organization (“MAO”), United paid Ms. Meador’s medical expenses from the time of her diagnosis of acute lithium toxicity on March 6, 2019 through the time of her death on June 15, 2019. On February 8, 2023, Optum, a subrogation agent acting on behalf of United, asserted a lien for the purposes of reimbursing United for the medical expenses for the treatment of the injuries Ms. Meador sustained on March 6, 2019. The Meadors challenged that lien in their motion for injunctive relief, seeking an order from the federal district court that United’s lien on any proceeds from their action is invalid.
The United States District Court for the District of Massachusetts stated in its February 13, 2024 Memorandum and Order that the parties do not dispute that the private cause of action provision applies to MAOs as to reimbursement or payments from primary payers. However, the Meadors are not primary payers, but rather individual beneficiaries of any settlement or damages that may arise from the lawsuit, and argue that the private cause of action provision does not extend to recovery against the beneficiaries of a lawsuit. “Although some courts have come to a different conclusion, this Court is persuaded by the majority of courts that have concluded that MAOs, like United, do not have a private right of action against beneficiaries, their attorneys or other non-primary payers … By its plain language, even considering it in light of the applicable regulations and by comparison to the government cause of action, the MSP allows only for recovery from primary plans … Moreover, the Meadors’ position that United does not have a viable lien here is perhaps strengthened by the fact that they are not seeking medical expenses. It follows from the statutory language that any recovery from the Meadors would have to be limited to reimbursement of medical expenses paid by United … Given that the Meadors’ claims did not include a claim for medical expenses, United would likely not be able to recover reimbursement of same from any resulting settlement or damages award … Accordingly, the Meadors have demonstrated a reasonable likelihood of success on the merits of defeating United’s lien.”
Meador v. United States of America, Case No. 22-cv-40024-DJC.
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