Filing # E-Filed 01/02/ :46:38 PM

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1 Filing # E-Filed 01/02/ :46:38 PM MSPA CLAIMS 1, LLC, a Florida limited liability company, IN THE CIRCUIT COURT OF THE 11 TH JUDICIAL CIRCUIT IN AND FOR MIAMI-DADE COUNTY, FLORIDA CASE NO.: CA-21 v. Plaintiff, IDS PROPERTY CASUALTY INSURANCE COMPANY, Florida Profit Corporation, Defendant. PLAINTIFFS NOTICE OF COMPLIANCE WITH COURT S ORDER Plaintiff MSPA Claims 1, LLC ( MSPA ), hereby files this Notice of Compliance with the Court s December 20, 2018 pronouncement in open court that the parties confer and agree to the language to be used in the Notice of Class Action. 1. On January 1, 2018 the Defendant, IDS Property Casualty Insurance Company ( IDS ), filed its Objection to Plaintiffs Proposed Notice of Class Action. 2. In its objection, IDS proposed addition to specific language for the Opt-out portion and incorporated all of the red lines that were accepted during the Court s in camera hearing. 3. MSPA reviewed IDS s proposed language to the Opt-out portion of the notice as well as the red lines and after conferring with IDS, has no objection to the changes suggested. 4. Attached as Exhibit A is the Notice of Class Action as reviewed in camera by the Court, and later redlined and approved by both parties as to the language of the Notice of Class Action in compliance with this Court s Order. CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of this document has been served by the Court s e-portal system on this 2 nd day of January, 2018, to all counsel of record. Irene Motles

2 Maynard Cooper & Gale 1901 Sixth Avenue North Regions Harbert Plaza Suite 2400 Birmingham, AL Dated: January 2, Respectfully submitted, MSP Recovery Law Firm Counsel for Plaintiff 5000 S.W. 75th Avenue, Suite 400 Miami, Florida Telephone: (305) By: /s/ John H. Ruiz John H. Ruiz, Esq., Fla. Bar No Service

3 EXHIBIT A IN THE CIRCUIT COURT OF THE 11th JUDICIAL CIRCUIT IN AND FOR MIAMI-DADE COUNTY, FLORIDA MSPA Claims 1, LLC, Plaintiff, v. IDS Property Casualty Insurance Company, Defendant, / CASE NO: CA-01 Judge Antonio Arzola NOTICE OF CLASS ACTION To: All Florida Medicare Advantage Organizations ( MAOs ) and/or their assignees, including but not limited to MSOs, IPAs, physicians, hospitals, and skilled nursing facilities, that paid for the medical care and treatment of enrollees who were insured under auto insurance policies issued by IDS Property Casualty Insurance ( IDS ) and were injured in a motor vehicle-related accident between December 2, 2009 through and including April 20, 2017 (the Class Period ). A Florida state court has authorized this notice. This is not a lawyer solicitation. PLEASE READ THIS NOTICE CAREFULLY AND IN ITS ENTIRETY. YOUR RIGHTS WILL BE AFFECTED BY THIS CLASS ACTION LAWSUIT. YOU HAVE NOT BEEN SUED. Litigation Currently Pending Before: The Honorable Antonio Arzola Circuit Court Judge, Eleventh Judicial Circuit Miami-Dade County, Florida 73 West Flagler Street, DCC 1110 Miami, Florida *PLEASE DO NOT CONTACT THE COURT* Page 1 of 9

4 Contents I. PURPOSE OF THE NOTICE...2 II. THE LITIGATION...3 III. CLASS MEMBERS...4 IV. YOUR OPTIONS AS A CLASS MEMBER...4 V. ABOUT THE CLASS REPRESENTATIVE AND CLASS COUNSEL...5 VI. CLAIMS PROCEDURE...6 VII. CONTACT INFORMATION...6 I. PURPOSE OF THE NOTICE This Notice is being sent to inform you of a class action lawsuit that is now pending in the Circuit Court of the Eleventh Judicial Circuit in and for Miami-Dade County, Florida (the Court ) under the above caption (the Action ) on behalf of the following MAOs: 1. Aetna Health Inc. d/b/a Coventry Health Plan of Florida, Inc. 2. AHF MCO of Florida, Inc. d/b/a Positive Healthcare 3. Amerigroup Florida, Inc. 4. AvMed, Inc. d/b/a AvMed Health Plans 5. Behealthy Florida, Inc. d/b/a Florida Blue 6. Better Health, Inc. 7. BlueMedicare Preferred HMO 8. Capital Health Plan, Inc. 9. CarePlus Health Plans, Inc. 10. Cigna Healthcare of Florida, Inc. 11. Eden Health Plans, Inc. 12. Florida Health Care Plans 13. Florida Health Solution HMO Company 14. Florida Healthcare Plus 15. Florida MHS, Inc. d/b/a Magellan Complete Care 16. Florida True Health, Inc. 17. Freedom Health, Inc. 18. Health First Health Plans, Inc. 19. Health Options, Inc. d/b/a Florida Blue HMO 20. HealthSpring of Florida, Inc. d/b/a Leon Medical Centers Health Plans 21. HealthSun Health Plans, Inc. 22. Healthy Palm Beaches, Inc. 23. Humana Health Insurance Company of Florida, Inc. 24. Humana Insurance Company 25. Humana Medical Plan, Inc. 26. Medica HealthCare Plans, Inc. 27. Molina Healthcare of Florida 28. Neighborhood Health Partnership, Inc. 29. Optimum HealthCare, Inc. 30. Preferred Care Partners, Inc. 31. Preferred Medical Plan, Inc. 32. Simply Healthcare Plans, Inc. d/b/a Clear Health Alliance 33. Sunshine State Health Plan, Inc. 34. The Public Health Trust of Dade County d/b/a JMH Health Plan 35. Ultimate Health Plans, Inc. 36. UnitedHealthcare of Florida, Inc., and 37. WellCare of Florida, Inc. Page 2 of 9

5 A full list of known assignees of MAOs, first-tier entities 1, downstream entities 2, Independent Physician Associations ( IPAs ) and Management Service Organizations ( MSOs ) obtained from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services ( CMS ) on can be found at: The Court has not decided whether MSPA Claims 1, LLC is correct. By authorizing this Class and authorizing this Notice, the Court is not suggesting that MSPA Claims 1, the Plaintiff, will win or lose this case. The Plaintiff must prove its claims at trial unless this case is resolved by settlement or dismissed by the Court. There is no money available now, and no guarantee there will be. However, your legal rights are affected, and you must decide now whether to remain a member of the Class, as defined below in Section III, or opt out of the Class. Your options are explained in this notice in Section IV below. To opt out, you must act before (within 45 days of the Class Notice). If money or benefits are obtained from IDS, you will be notified about how to ask for a share of the recovery. If you remain in the case, all claims that may be owed to you by IDS can be prosecuted in this litigation. Class Counsel will provide you with details as to the process of providing proof for your claims. Any questions not answered by this Notice of Pendency of Class Action (the Notice ) should be directed to Class Counsel and not to the Court. Class counsel have established a system for any questions that you may have, please refer to page (4) for information on class counsel and how to submit your questions and claims. II. THE LITIGATION On December 2, 2015, MSPA Claims 1, LLC ( Plaintiff ) as an alleged assignee of Florida Healthcare Plus ( FHCP ), an MAO, through the claims of an enrollee of FHCP, filed a lawsuit against IDS Property Casualty Insurance Company ( IDS or Defendant ), on behalf of itself, and a class consisting of all Florida MAOs to whom it alleges IDS failed to provide primary payment and/or appropriate reimbursement of alleged conditional payments provided on behalf of Medicare enrollees. IDS is a no-fault insurer that issues policies of insurance pursuant to Florida s No-Fault law that provides statutorily required benefits pursuant to sections , Florida Statutes and is, otherwise, considered a primary plan pursuant to the Medicare Act. See 42 U.S.C. 1395y(b)(2)(A) (defining primary plan to include no fault insurance); 42 C.F.R (same); Fla. Stat (4) (indicating benefits due from a [] [nofault] insurer under ss are primary ). Plaintiff alleges its claims arise from injuries sustained by an enrollee of FHCP ( Enrollee ), while Enrollee was traveling in a motor vehicle. The claims asserted in Plaintiff s Amended Class Action Complaint are for those services and/or supplies paid by FHCP to treat the injuries suffered by its Enrollee as a direct result of the motor vehicle accident. In addition to having been an enrollee with FHCP at the time of the accident, Enrollee was also 1 First tier entity means any party that enters into a written arrangement, acceptable to CMS, with an MA organization or applicant to provide administrative services or health care services for a Medicare eligible individual under the MA program. 42 C.F.R Downstream entity means any party that enters into a written arrangement, acceptable to CMS, with persons or entities involved with the MA benefit, below the level of the arrangement between an MA organization (or applicant) and a first tier entity. These written arrangements continue down to the level of the ultimate provider of both health and administrative services. Id. Page 3 of 9

6 covered by a Florida No-Fault insurance policy issued by IDS. Plaintiff alleges that FHCP advanced Medicare payments on behalf of Enrollees for medical care and treatment for which IDS was responsible as a primary payer and seeks to recover under F.S and the Medicare Secondary Payor Act ( MSP Law ). IDS asserts that it paid its policy limits and contests Plaintiff s claims. As an MAO, FHCP alleges that Medicare payments on behalf of Enrollee for medical care and treatment for which IDS was responsible as a primary payer since Enrollee s medical bills arose from the ownership, maintenance, and/or use of a motor vehicle , Fla. Stat. (2016). Accordingly, Plaintiff seeks damages on behalf of itself and similarly situated Florida MAO s or their assignees for IDS s alleged violation of section and the Medicare Secondary Payer Law ( MSP Law ). A copy of all pleadings can be viewed by visiting: III. CLASS MEMBERS The Class as certified by the Court, consists of entities that: contracted directly with the Centers for Medicare and Medicaid Services ( CMS ) and/or its assignee pursuant to Medicare Part C, including but not limited to, MAOs and other similar entities, to provide Medicare benefits through a Medicare Advantage plan to Medicare beneficiaries for medical services, treatment, and/or supplies as required and regulated by HHS and/or CMS as a direct payer of medical services/supplies and/or drugs on behalf of Medicare beneficiaries either for parts A, B and/or D, all of which pertain to the same medical services and/or supplies that were the primary obligation of the Defendant; have made payment(s) for medical services, treatment and/or supplies subsequent to December 2, 2009, whereby the MAO, or its assignee, as a secondary payer, has the direct or indirect right and responsibility to obtain reimbursement for covered Medicare services, for which the Defendant, as the primary payer pursuant to Defendant s contract covering the Medicare enrollee pursuant to Florida No-Fault law (section (4), Florida Statute), was/is financially responsible to a Medicare beneficiary for medical bills incurred as a result of the use, maintenance or operation of a motor vehicle; and where the Defendant failed to properly pay for medical bills on behalf of its insureds and has otherwise failed to reimburse the MAO s or its assignees for their payment(s) as calculated pursuant to the recognized Current Procedure Terminology ( CPT ) codes based on the fee-for-service by the primary payer, as delineated by section , Florida Statues, for medical services and/or supplies for their damages 3. You may qualify if you are encompassed in the definition above. IV. YOUR OPTIONS AS A CLASS MEMBER 3 The Class entities have not otherwise released their right to reimbursement as secondary payers. Page 4 of 9

7 1. Do Nothing If you do nothing, you will automatically be part of this lawsuit if you are a member of the Class. The Plaintiff and Class Counsel will represent your interests in the prosecution of the claims against Defendant. As a member of the Class, you will not be responsible for any attorneys fees or costs except that the trial court may award fees and costs to Class Counsel out of any recovery. Any judgment for or against Plaintiff, or any settlement in this case, will apply to you. 2. Separate Counsel You can elect to be part of this lawsuit, but not be represented by Class Counsel, and instead, either represent yourself or have your own lawyer represent you. You will need to affirmatively enter an appearance or have your own lawyer enter an appearance in the lawsuit if you choose this option. If you elect to hire your own lawyer, you will be responsible to pay your lawyer s fees and costs. 3. Opt Out Alternatively, you have a right to not be part of this Lawsuit by excluding yourself or opting out of the Class. By opting out of the Class: (1) your interests will not be represented by Class Counsel and you will not be bound by the outcome of this Lawsuit unless you seek to intervene in this Lawsuit; (2) In the event of a favorable judgment, you will not share in the recovery; (3) In the event of an unfavorable judgment, you may still assert the same or similar claims you have against IDS; (4) You will not be entitled to notice of or an opportunity to be heard regarding any proposed settlement or dismissal of the Lawsuit; (5) You will not be entitled to share in any settlement proceeds obtained on behalf of the Class; (6) Your claim will not be represented by class counsel; (7) You will have to seek independent representation; (8) You will need to provide evidence to prove your own claims; and (8) If you choose this option, you should talk with an attorney soon as you also run the risk of allowing your claim to expire as laws may apply that bar you from filing unless done so within the statute of limitations period. To opt-out, you must complete the electronic opt out form located at The request to exclude yourself must be submitted on or before (45 days of this Class Notice), and must include your full name/entity name, address, electronic signature from an authorized representative and a statement that you wish to be excluded from the Class. V. ABOUT THE CLASS REPRESENTATIVE AND CLASS COUNSEL The Court certified the following attorneys as Class Counsel: John H. Ruiz, Esq., Frank C. Quesada, Esq., and Gonzalo Dorta, Esq. (collectively Class Counsel ). These attorneys will represent you as part of the Class, unless you choose to hire your own attorney, which you have a right to do, at your own expense. VI. CLAIMS PROCEDURE Using a software system ( MSP System ) designed and developed by Plaintiff and its counsel, Plaintiff has implemented a methodology to capture, compile, synthesize and funnel large amounts of data in order to identify claims class-wide. The MSP system captures data from different sources to identify the class-member enrollees medical expenses incurred as a result of an automobile accident and which should have been paid for by Defendant. The MSP System can also identify the amounts owed by using the Defendant s electronic data, the MAO s data and data acquired from outside sources like the Department of Motor Vehicles, ISO and CMS. Plaintiff merges the Defendant s own data with the information available on the MSP System to discover and Page 5 of 9

8 identify a Medicare eligible person for whom primary medical payments should have been made along with any information stored to potential class members. Plaintiff s claims analysis methodology utilizes International Classification of Diseases Codes ( ICD Codes ) and Current Procedural Terminology Codes ( CPT Codes ) commonly used in the healthcare and automobile insurance industries, to identify and obtain any information regarding an enrollees underlying case, such as the type of injury suffered, the circumstances that caused the injury, whether the listed primary insurance provider made payment, and whether the insurance carrier was a no-fault provider. Upon obtaining this information Plaintiff uses complex algorithms to place the extracted electronically stored information into separate data fields. The algorithm is a mathematical command given to the software to recognize certain data fields. Plaintiff then matches the data with other sources of publicly available \data such as, car crash reports, ISO reports responsibility, and the MAOs claims data. Plaintiff has also obtained from the Florida Department of Motor vehicles all automobile crash reports for every automobile crash in Florida from 2006 to the present. When Plaintiff collects the Explanation of Benefits (EOB) from the Defendant which contains information related to the claimant, date of birth, claim number, date of loss, coverage clear, deductible, no-show and provider number, Plaintiff integrates this information into its system to identify whether PIP benefits for an insured have been exhausted and whether the benefits have been paid properly. Plaintiffs system also accesses federal, state and county court dockets throughout Florida to identify additional instances in which an enrollee of Defendant or a putative class member may be involved in a lawsuit related to a recoverable claim. VII. CONTACT INFORMATION PLEASE DO NOT CONTACT THE COURT For further information regarding the nature and/or scope of this litigation, questions regarding Class Certification, or to discuss pertinent data for the lawsuit, please contact Class Counsel: MSP Recovery Law Firm Attn: John H. Ruiz, Esq S.W. 75th Avenue, Suite 400 Frank C. Quesada, Esq. Miami, FL Telephone: (305) Dorta Law 334 Minorca Avenue Attn: Gonzalo Dorta. Esq. Coral Gables, Florida Telephone: (305) IDSClassAction@MSPRecovery.com This Notice has been sent via electronic mail, USPS Certified Mail and/or fax to the entities identified in the Court s Class Certification Order, including Medicare Advantage Organizations, and First Tier entities. For more information visit: This website contains additional information or download the MSP Recovery App to obtain current and future push notifications. Page 6 of 9

9 Step 1 select Class Actions Page 7 of 9

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11 Step 3 Additional Case Details Page 9 of 9