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Osborne v. Metropolitan Government of Nashville and Davidson County

United States Court of Appeals, Sixth Circuit

August 20, 2019

Ronald Osborne, Plaintiff-Appellant,
v.
Metropolitan Government of Nashville and Davidson County, Defendant-Appellee.

          Appeal from the United States District Court for the Middle District of Tennessee at Nashville. No. 3:18-cv-00390—Aleta Arthur Trauger, District Judge.

         ON BRIEF:

          James Bryan Moseley, MOSELEY & MOSELEY, Murfreesboro, Tennessee, for Appellant.

          J. Brooks Fox, METROPOLITAN GOVERNMENT OF NASHVILLE AND DAVIDSON COUNTY, Nashville, Tennessee, for Appellee.

          Before: SILER and DONALD, Circuit Judges. [*]

          OPINION

          SILER, CIRCUIT JUDGE.

         Plaintiff 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.

         I.

         Due to 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.

         Osborne 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.[1] The award was upheld on appeal in 2018.

         This 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 payments.[2]

         Osborne 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.

         II.

         This 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 ...


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