Category Archives: Medicare Conditional Payments

Blog, Legal/Legislative News, Medicare Advantage Part C

Over the past several years, we have witnessed Medicare Advantage Plans (MAPs) flex their muscles in establishing their rights to recover double damages through a Medicare Secondary Payer (MSP) private cause of action for double damages against “primary plans” (workers’ compensation, liability, and no-fault insurance carriers/self-insured entities) for failure to timely reimburse MAP conditional payments. Well known and important decisions …
READ MORE

The Grinding Gears of CMS Regulation

27 Jun 2017 John Williams No Comments

Blog, Franco Signor News, Legal/Legislative News, Medicare Conditional Payments, Medicare Reporting Section 111, Medicare Secondary Payer News, Medicare Set Aside

The Grinding Gears of CMS Regulation A CLM Magazine Article by John Williams and Heather Sanderson Personal Injury and No-Fault Payers Should be Aware of Three Compliance Issues  As the Centers for Medicare and Medicaid Services (CMS) faces mounting pressure to address financial challenges, the agency is looking for methods to recover over-payments and ensure that it does not make a …
READ MORE

Blog, Medicare Conditional Payments, Medicare Secondary Payer News, Reimbursements

The California Insurance Guaranty Association (CIGA) is California’s largest workers’ compensation provider as the insurer of last resort for employers who would otherwise not be able to afford the mandatory coverage.  Because it operates for all intents and purposes as an adverse risk pool, it must exercise care in payments it makes for worker’s compensation claims that result.  Consequently, when …
READ MORE

Expanded Recoveries on the Horizon

12 Apr 2017 John Williams No Comments

About Franco Signor, Blog, Franco Signor News, LMSA, Medicare Conditional Payments, Medicare Secondary Payer News

In a recent blog, Heather Sanderson highlighted the success of MSP Recovery LLC (Plaintiff) certifying a class of Florida Medicare Advantage Organizations (MAOs) that had claims where a non-group health plan (NGHP) failed to make primary payment.   In the filings, the Plaintiff is indicating that they have access to data from the Defendant, MAO, DMV, ISO, and CMS.   With this …
READ MORE

Blog, Legal/Legislative News, Medicare Conditional Payments, Medicare Secondary Payer News, MSPRC Appeals

In a decision out of the Southern District of Florida, Shapiro v. Secretary of HHS, 2017 U.S. Dist. LEXIS 42278 (March 23, 2017), the District Court affirmed a final decision of the Medicare Appeals Council (“MAC”) rejecting a Medicare beneficiary’s challenge to Medicare’s conditional payment recovery. The Medicare beneficiary Plaintiff, Barbara Shapiro (“Shapiro”), was injured in an automobile accident with …
READ MORE

Part D MSP Reform Legislation Re-Introduced in Congress

20 Feb 2017 Heather Sanderson No Comments

Blog, Legal/Legislative News, Pharma Part D

On Thursday, February 16, Congressman Tim Murphy (R-PA) and Congressman Ron Kind (D-WI) re-introduced the Secondary Payer Advancement, Rationalization, and Clarification Act (SPARC Act – H.R. 1122) into the US. House of Representatives. For our prior blog and a detailed overview of the SPARC Act, click here. For Congressman Tim Murphy’s press release on the SPARC Act’s re-introduction, click here. …
READ MORE

Blog, Medicare Conditional Payments

Franco Signor always take the position on behalf of our Clients to aggressively dispute unrelated charges related to Medicare’s claim for conditional payment reimbursement.  Our efforts have resulted in well over 90% reductions in charges because of it.  This case, brought by the California Insurance Guarantee Association (CIGA) explains why it is important to remain proactive in managing your conditional …
READ MORE

Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Secondary Payer News, Pharma Part D, Reimbursements

The Medicare Advocacy Recovery Coalition (MARC) worked diligently over the past eighteen months to develop and introduce the Secondary Payer Advancement, Rationalization and Clarification Act of 2016 (SPARC). Representatives Tim Murphy (18th District Pennsylvania, Republican) and Ron Kind (3rd District Wisconsin, Democrat) sponsored this bipartisan legislation that was immediately referred to the two committees of jurisdiction over Medicare – House …
READ MORE

Blog, Franco Signor News, Legal/Legislative News, Pharma Part D

On September 24, 2016, legislation was introduced to clarify Part D Drug Plans reimbursement rights under the Medicare Secondary Payer law. The legislation will reinforce for these Plans a clear right of subrogation and improvement in Section 111 MMSEA data for improved coordination. To learn more about the proposed legislation, click here. Congratulations to the Medicare Advocacy Recovery Coalition for …
READ MORE

© 2012-2017 Franco Signor LLC