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14 Sep 2017 Jesse Hamby No Comments
About Franco Signor, Legal/Legislative News, Pharma Part D
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14 Sep 2017 Heather Sanderson No Comments
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 …
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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 …
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04 May 2017 Heather Sanderson No Comments
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 …
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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 …
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27 Mar 2017 Heather Sanderson No Comments
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 …
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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. …
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11 Jan 2017 Heather Sanderson No Comments
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 …
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18 Oct 2016 Roy Franco No Comments
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 …
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26 Sep 2016 Roy Franco No Comments
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 …
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