01.11.10
Monsanto Case: Conditional Payments Before and After Settlement Date (Part 1)
On December 1, 2009, The United States filed suit to recover conditional payments owed from a class action settlement. See CV 09-PT-2423-E, U.S.A. v. Stricker et al. While the complaint was short and only attached the master settlement documents, it appears that the United States may be seeking reimbursement for conditional payments made both before and after the settlement date. Specifically, the settlement agreement provide for compensation for “primary health care and/or assist in gaining access to primary health care and other health care services (including but not limited to lab, dental, outreach, pre-natal care, radiology, case management, pharmacy, preventive medicine, holistic medicine, and other health care programs) by making grants or payments for the actual benefit of persons meeting the criteria.” The Complaint is unclear whether it is claiming reimbursement for both conditional payments before settlement and those not conditional payments made from the settlement fund. So the question remains, is CMS seeking reimbursement for the pre-2003 expenses only, or for post 2003 expenses as well?
Other legal issues that may be clarified from this action are the “mandatory” reporting requirement of 42 C.F.R. 411.25 (2003). These requirements are different than the current regulation. Further, how does the statute of limitations apply as CMS was/were aware of these claims in 2003 per its Complaint. Does the six year theory still prevail when CMS had notice of claims over six years ago? Protocols will keep the community posted pursuant to this blog. Answers for the defendants are not due until the end of January, absent any extensions of time.
