from the United States District Court for the Middle District
of Tennessee at Nashville. No. 3:18-cv-00390âAleta Arthur
Trauger, District Judge.
Bryan Moseley, MOSELEY & MOSELEY, Murfreesboro,
Tennessee, for Appellant.
Brooks Fox, METROPOLITAN GOVERNMENT OF NASHVILLE AND DAVIDSON
COUNTY, Nashville, Tennessee, for Appellee.
Before: SILER and DONALD, Circuit Judges. [*]
Ronald Osborne appeals the district court's decision
dismissing his claim under the Medicare Secondary Payer Act
("MSPA"), 42 U.S.C. § 1395y(b), against the
Metropolitan Government of Nashville and Davidson County
("Metro Nashville"). Because the MSPA does not
provide Osborne a cause of action, the district court's
decision is AFFIRMED.
an unsafe condition on the premises, Osborne suffered a
broken arm while throwing away trash at the East Nashville
Convenience Center in 2014. The center is owned and operated
by Metro Nashville.
obtained a judgment against Metro Nashville in state court
under the Tennessee Governmental Tort Liability Act; the
damages included specific medical expenses related to the
incident and found Osborne's comparative fault to be
twenty percent. The award was upheld on appeal in 2018.
lawsuit arises because, prior to the state court suit,
Osborne incurred medical expenses for which Metro Nashville
did not pay at the time. Instead, and since Osborne is a
Medicare recipient, Medicare made conditional payments to
Osborne totaling at least $9, 453.09. Because Metro Nashville
failed to pay, Osborne claims he himself incurred-in addition
to the costs of his state court litigation-the "cost of
paying his co-pays, deductibles, and co-insurance for the
treatment from his medical providers which was not covered
through Medicare." According to the amended complaint,
Metro Nashville still has not paid the state court judgment
or reimbursed Medicare for its conditional
brought this suit in the Middle District of Tennessee
alleging Metro Nashville is a primary payer who failed to pay
under the MSPA, and is therefore liable for reimbursement of
Medicare's conditional payments and a double damages
penalty pursuant to 42 U.S.C. § 1395y(b)(3)(A). The
district court held that Osborne lacked statutory standing to
sue for his individual losses and the conditional payments
made by Medicare because the MSPA does not permit a private
cause of action against tortfeasors. Because the MSPA is not
a qui tam statute and financial injury suffered by Medicare
is not attributed to Osborne, the district court found that
he also lacked Article III standing to sue for Medicare's
conditional payments. Finally, it noted that the individual
harms claimed by Osborne in his complaint were conclusory and
insufficient to survive a motion to dismiss.
court reviews a district court's grant of a motion to
dismiss de novo. Keys v. Humana, Inc., 684 F.3d 605,
608 (6th Cir. 2012). The complaint is construed in a light
most favorable to the plaintiff, and the court accepts all
well-pleaded factual allegations as true. Crugher v.
Prelesnik, 761 F.3d 610, 614 (6th Cir. 2014). Those
factual allegations must be enough "to state a ...