Congress Granted MA Organizations Private Cause of Action, Third Circuit Rules

Tthe U.S. Court of Appeals for the Third Circuit June 28 ruled that Congress granted Medicare Advantage organizations a private cause of action to enforce their rights as secondary payers (In re Avandia Marketing, Sales Practices & Products Liability Litigation, 3d Cir., 11-2664, 6/28/12).

The appeals court reversed a ruling by the U.S. District Court for the Eastern District of Pennsylvania that dismissed a lawsuit by Humana Medical Plan Inc. and Humana Insurance Co. against GlaxoSmithKline alleging GSK failed to reimburse Humana for treatment costs associated with GSK’s diabetes drug, Avandia (20 HLR 996, 6/30/11). ...