04 Mar 2019 Heather Sanderson No Comments
Blog, Legal/Legislative News, Medicare Conditional Payments
A new decision by the U.S. District Court for the Middle District of Pennsylvania, entitled United States v. Angino, 2019 U.S. Dist. LEXIS 30499 (February 26, 2019), which involves the United States filing a lawsuit to recover conditional payments from the plaintiff attorney, Medicare beneficiary, and “primary plan” caught our attention. The lawsuit reignites the debate on whether the parties …
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14 Feb 2019 Heather Sanderson No Comments
Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Conditional Payments
The Non-Group Health Plan (NGHP) industry is not only experiencing increased recovery demands from Medicare Advantage Plans (MAPs) as of recently, but are also experiencing MAPs attempting to assert a greater right of recovery for conditional payments than traditional Medicare would have available. As a foundational matter, there are certain parameters laid out in the Medicare Secondary Payer Act (MSP) …
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20 Nov 2018 Heather Sanderson No Comments
Blog, Medicare Conditional Payments, Medicare Jurisdiction
As required by section 202 of The SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts. For the last two years 2017-2018, CMS has maintained the threshold of $750 across all non-group health plan (NGHP) lines of business- workers’ compensation, liability, and no-fault insurance. The threshold means that if …
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13 Nov 2018 Heather Sanderson No Comments
Blog, Medicare Secondary Payer News, Medicare Set Aside, Pharma Part D, WCMSA
What is the intended purpose behind a Workers’ Compensation Medicare Set-Aside (WCMSA)? The WCMSA Reference Guide, Section 3.0 states: “A WCMSA allocates a portion of the WC settlement for all future work-injury-related medical expenses that are covered and otherwise reimbursable by Medicare (“Medicare covered”) (emphasis added). Accordingly, Medicare through its issued guidance has provided that medical expenses should not be …
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18 Oct 2018 Heather Sanderson No Comments
Blog, Medicare Secondary Payer News, Pharma Part D
Recently, CMS updated its Part D Manual to include specific changes to the Manual’s Medicare Secondary Payer (MSP) provisions. The updated manual can be found here. Page 40 now provides: “Part D sponsors are responsible for adjudicating enrollees’ claims in accordance with MSP requirements. Under CMS’ adjudication logic for Part D MSP claims, the provider/pharmacy receives at least the Part …
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08 Oct 2018 Heather Sanderson No Comments
About Franco Signor, Medicare Advantage Part C
Primary plans must consider best practices as courts rule in favor of MAPs recovering double damages. Read Full Article from CLM Magazine
27 Sep 2018 Heather Sanderson No Comments
Blog, Medicare Advantage Part C, Trial Practice
Recall MSP Recovery LLC, a law firm out of Miami, Florida that has been initiating numerous class action litigation country-wide as assignees on behalf of Medicare Advantage Plans (MAPs) alleging that various primary payers have failed to reimburse MAP conditional payments allegedly giving rise to a Private Cause of Action under the Medicare Secondary Payer Act (MSP), specifically located at …
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23 Jul 2018 Heather Sanderson No Comments
Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Jurisdiction, Medicare Secondary Payer News
Reprinted from the Morning Consultant In health policy, the minutia is not trivial; it’s essential. Small incentives created by policymakers can have a significant impact upon how Medicare beneficiaries, doctors, hospitals and insurers respond to health care claims. But sometimes policies — even the most well-intentioned — can have unintended consequences, leading to wasted resources, burdensome regulations and broken promises …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Conditional Payments
Earlier this year, we blogged about an action by MSP Recovery LLC against State Farm being dismissed. Recall that MSP Recovery LLC is an entity out of Miami, Florida that has been filing litigation and class actions nationwide on behalf of Medicare Advantage Plans (MAPs) against primary plans for the alleged failure to reimburse conditional payments to the MAP. For …
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Blog, Medicare Conditional Payments, Trial Practice
A press release has been issued by the U.S. Attorney’s Office for the Eastern District of Pennsylvania announcing that U.S. Attorney William McSwain has entered into a settlement with a Philadelphia personal injury law firm, Rosenbaum & Associates, and its principal, Jeffrey Rosenbaum, Esq. to resolve allegations that they failed to reimburse the United States for certain Medicare payments the government …
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