Doubling Down on Damages: As MAP Enrollment Gains Momentum, So Does the Risk for a Private Cause of Action

Medicare Advantage Plans (MAPs), also known as Medicare Part C, are private insurance plans that provide for a Medicare beneficiary’s Part A and Part B benefits. Beneficiaries can choose to enroll in a MAP rather than traditional Medicare. There also are Medicare drug plans (Part D) that provide for a beneficiary’s prescription drugs.

As of Jan. 17, 2023, more than 30 million Americans are enrolled in MAPs, according to data published by the Centers for Medicare and Medicaid Services (CMS). Moreover, there are nearly 4,000 MAPs available nationwide, which is nearly double the number of available plans in 2010.

While case law across the country is scattered on what degree of recovery rights MAPs have for conditional payments, at the very least, MAPs surely have rights to recover the conditional payments they have made, like any other medical lien. Additionally, several jurisdictions across the country have determined that MAPs have the right to recover double damages for conditional payments under the MSP private cause of action if the primary insurance payer fails to reimburse the MAP.