In Bronson Healthcare Group, Inc. v Conifer Insurance Company (Feb. 2, 2026), the Michigan Court of Appeals issued an important published decision limiting when a medical provider may bring a private cause of action for double damages under the Medicare Secondary Payer Act (MSPA). The Court held that an MSPA private action cannot proceed unless the insurer's responsibility to pay has first been demonstrated, making demonstrated responsibility a condition precedent to suit.

The Court emphasized that good-faith coverage disputes—such as whether an injured individual qualifies as an employee under workers' compensation—do not trigger MSPA liability until responsibility is established through a judgment, settlement, or equivalent determination. In rejecting the Sixth Circuit's broader interpretation, the Court aligned with federal precedent holding that the MSPA was not intended to punish insurers for legitimately contesting coverage.

This decision protects insurers and employers from being forced into premature MSPA litigation while workers' compensation or coverage disputes are still being lawfully litigated. It prevents MSPA claims from being used as leverage to bypass administrative proceedings, reduces the risk of duplicative or inconsistent rulings, and confirms that double damages are not a penalty for good-faith coverage disputes.

Bottom line: MSPA exposure does not attach until responsibility is established and reimbursement is then improperly withheld.

If you have questions or comments related to these issues, or any legal issues related to insurance, contracts, and similar matters, please contact Nicole G Bien at Kallas & Henk, PC to discuss in more detail.