Lynette Duncan, as Personal Representative of the Estate of David Duncan, Deceased v. Liberty Mutual Insurance Company

This case cleanly presents an acknowledged circuit conflict over Article III standing in cases under the Medicare Secondary Payer Act (MSPA). Under the MSPA, a patient may sue her private insurer if it denies coverage, requiring Medicare to pay the patient’s bills instead. Medicare gets reimbursed from the plaintiff’s recovery. To encourage patients to sue insurers who wrongfully deny coverage and force Medicare to step in, the MSPA provides for double damages. Once Medicare recovers its payments, the plaintiff keeps the remainder. Most circuits agree that “a plaintiff is injured when a defendant was obligated under law to pay for her medical care but didn’t,” even if “Medicare paid for her treatment” instead. Netro v. Greater Baltimore Med. Ctr., Inc., 891 F.3d 522, 526 (4th Cir. 2018) (cleaned up). That conclusion accords with centuries of precedent holding that a breach of contract opens the courthouse doors, regardless of any other loss to the plaintiff. Here, however, in a 2-1 decision that acknowledged its departure from other circuits, the Sixth Circuit rejected that longstanding rule. It held that when Medicare has covered a plaintiff’s medical bills, the plaintiff lacks Article III standing to sue an insurer who wrongfully denies coverage—a conclusion that, in the Fourth Circuit’s words, “essentially render[s] Congress’s express provision of the private cause of action null and void.” Id. at 528. The question presented is: Does a person suffer Article III injury-in-fact when an insurer breaches its contractual obligation to pay for the person’s medical care? (I) 276878.1