Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

GARIANO v. CSC INS. CO.

March 3, 1994

LOUIS GARIANO, Plaintiff,
v.
CSC INSURANCE COMPANY, Defendant and Third-party Plaintiff, v. PENNSYLVANIA BLUE SHIELD and PENNSYLVANIA BLUE SHIELD MEDICARE, Third-party Defendants.



The opinion of the court was delivered by: STANLEY S. BROTMAN

 Brotman, J.

 Before the court are the motions of third-party defendants Pennsylvania Blue Shield ("Blue Shield") and Pennsylvania Blue Shield Medicare ("PBS Medicare") to dismiss--or for summary judgment against--the claim brought against them by defendant/third-party plaintiff CSC Insurance Company ("CSC"). As detailed below, the court concludes that CSC lacks standing to maintain an action against Blue Shield and PBS Medicare. Accordingly, the motions will be granted.

 I. Facts and Procedural Background

 Plaintiff Louis Gariano attempts in this case to obtain insurance payment for medical expenses related to injuries he sustained in a 1989 automobile accident. Mr. Gariano initiated the instant action in New Jersey Superior Court against CSC, with whom plaintiff held an automobile insurance policy, upon CSC's refusal to pay for the claimed expenses. CSC, alleging that plaintiff's claim is not covered under its policy but is covered by plaintiff's policies with Blue Shield and PBS Medicare, subsequently joined Blue Shield and PBS Medicare as third-party defendants. In its third-party complaint, CSC seeks a judgment ordering the third-party defendants to pay the claims of the plaintiff and to indemnify and/or contribute to any judgment entered against CSC.

 On November 25, 1992, PBS Medicare and Blue Shield removed the instant action to this court, pursuant to 28 U.S.C. § 1441(b). *fn1" On July 14, 1993 and July 19, 1993, PBS Medicare and Blue Shield respectively filed the instant motions. *fn2"

 II. Statutory Framework Governing PBS Medicare

 In Title XVIII of the Social Security Act (hereinafter the "Act"), 42 U.S.C. §§ 1395-1395ccc, Congress established the program of Health Insurance for the Aged and Disabled, popularly known as Medicare, which is paid for, in part, by the monthly contributions of Medicare beneficiaries. Beneficiaries of the program are individuals eligible for Social Security insurance benefits under Title II of the Act. See 42 U.S.C. § 401-433.

 Medicare, Part A, provides insurance for hospital, related post-hospital, and home health services. 42 U.S.C. §§ 1395c, 1395i-4. Part B is a voluntary subscription program of supplementary medical insurance covering charges for certain other services--primarily physician services, x-rays, laboratory tests, and some medical supplies. 42 U.S.C. §§ 1395j, 1395w-4; see also 42 U.S.C. §§ 1395k, 13951, 1395x(s).

 Donna E. Shalala, the Secretary of the Department of Health and Human Services ("HHS"), is responsible for administering the Medicare program. 42 U.S.C. § 1395kk. Pursuant to the Act, the Secretary is authorized to contract with public or private entities--characterized as "intermediaries" for Part A and "carriers" for Part B--to perform designated functions. *fn3" 42 U.S.C. §§ 1395h, 1395u(a); 42 C.F.R. § 421.100, .200. Among other authorized duties, these entities process and review claims submitted by beneficiaries or their assignees to determine if such claims are for covered services, and if so, to pay the proper amount to the claimant.

 The intermediary or carrier's claim-paying function is triggered by receipt of a claim or request for payment. Part A benefits are not paid to Medicare beneficiaries, such as Mr. Gariano, but are paid directly to the provider. 42 U.S.C. § 1395f. A provider is defined as

 
a hospital, rural primary care hospital, skilled nursing facility, comprehensive outpatient rehabilitation facility, home health agency, hospice program or [a hospital fund].

 42 U.S.C. § 1395x(u).

 Under Part B, claims are generally paid to the beneficiary; however the claim or request for payment also may operate as an assignment agreement when the beneficiary assigns his right to receive payment to the provider or supplier. In the case of an assignment, the provider or supplier submits the claim and receives payment. 42 U.S.C. § 13951; 42 C.F.R. § 405.802(c)(e). Any claimant--that is, a beneficiary or a provider or supplier who has accepted assignment--who disputes either the amount of payment provided on a Medicare claim or the outright ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.