Magistrate Denies Conditional Payment Reimbursement Request by MAP Plan

by P. Czuprynski

In Series v. State Farm Mut. Auto. Ins. Co., 1:23 CV 22982 (July 15, 2025), the Magistrate Judge agreed that Series’ suit for conditional payment reimbursement should be denied.

In the suit, Series claimed Medicare Advantage Plans (MAPs) assigned their right to seek reimbursement of conditional payments under the Medicare Secondary Payer Act and State Farm is responsible for reimbursement. In federal court, a Magistrate’s decision must be approved by the federal court judge overseeing the matter. Both parties have filed motions pending review by the federal court judge.

In this specific matter, the Magistrate determined that Series did not have standing to file suit and failed to demonstrate valid assignment from the MAPs. While this factor alone defeated Series’ request for conditional payment reimbursement, the Magistrate dove deeper into Series’ claim for reimbursement.

While we encourage readers to read the full decision, unfortunately it appears to only be available through certain subscriptions. But this post will only go into detail regarding the finding that the spreadsheet Series used to prove their case, was not admissible evidence at summary judgement.

Because we have seen MAPs use similar spreadsheets to prove their case in other matters, this decision could have a significant impact on future collections brought by MAPs.

MAPs do not have the ability to refer a debt to U.S. Treasury, so they must file suit and prove to a court that reimbursement is required. This requires specific pleading and evidentiary requirements that over the past decade we have seen courts deal with.

The Spreadsheets

The Magistrate found that the spreadsheets Series provided was not admissible as evidence to prove reimbursement was required under the MSP Act. The Magistrate found the spreadsheets lacked trustworthiness, were prepared for litigation, and not an adoptive business record.

The Magistrate identified that the spreadsheets provided by Series were created by combining claims data with other sources such as “MyAbility” reports, car accident reports, and/or information added by plaintiff. Series testified that the data they received from MAP plans was manipulated to provide the claim information that Series wanted for litigation.

For the 117 claims presented by Series, they made no claim they had copies of bills, payments, or accounting ledgers to support the payments made by the MAP plan. The Magistrate Judge found that these factors demonstrated the spreadsheets were created during the litigation or shortly before.

Adoptive business records may be admissible as evidence, but the Magistrate did not agree with Series that their spreadsheet qualified as adoptive business records. Rather, the Magistrate identified that Series altered the original claims data from the MAP plans and incorporated third party information from outside sources into the spreadsheets.

Moreover, the Magistrate identified that Series testified it did not know how the MAP plan compiled files related to the claim used in the spreadsheets and indicated these factors exhibited  a lack of trustworthiness, and the Magistrate would not admit the spreadsheets as evidence demonstrating reimbursement is required under the MSP Act.

What Does This Decision Mean for Carriers and Self-insureds?

Although the federal court judge does not have to approve the Magistrates recommendations, the Magistrate’s decision provides potential defenses that could defeat reimbursement requests  from some (not all) MAPs  including:

• • Invalid proof of assignment of claims
  • Other vendors were assigned conditional payment collection
  • Affidavits by MAP plan may contradict one another or not prove reimbursement is required
  • Spreadsheet used by MAP is not admissible evidence
    • Is spreadsheet is based on hearsay?
    • Can MAP plan provide supporting bills, payment information, or an accounting ledger?

Further, this decision amplifies the need to be highly critical of MAP collections. Especially when the MAP has assigned its right to collect to a third party.

It is also important to note  that the burden is on the MAP plan to prove that reimbursement is required under the MSP Act. This means the MAP plan must provide assertions and evidence that demonstrate the need for reimbursement. Simply saying reimbursement is required and providing a spreadsheet may not be enough for a federal court to require reimbursement.

We will provide updates as we learn more about this matter. If you have any questions about this case or would like to learn more about our Conditional Payment and Lien solutions, please contact us at [email protected].