Category Archives: Medicare Conditional Payments

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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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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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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MAPping Out a Course – An Article by Heather Sanderson

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 

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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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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MSP Recovery LLC and its Attorneys Sanctioned

12 Jun 2018 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Advantage Part C, Trial Practice

If you follow our blog, you will recall an entity called MSP Recovery LLC, a law firm in Miami, Florida which alleges to have received assignments on behalf of various Medicare Advantage Plans (MAPs) to pursue double damages Medicare Secondary Payer (MSP) private cause of action lawsuits and class actions nationwide. The allegation by MSP Recovery in these lawsuits are …
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Blog, Legal/Legislative News, Medicare Advantage Part C

We have previously blogged about the PAID Act- legislation promulgated by the Medicare Advocacy Recovery Coalition (MARC) which, if passed, would enable Responsible Reporting Entities (RREs) to have insight into Medicare Advantage Plan, Medicare Part D, and Medicaid enrollment information. This data would be provided in the query response file via MMSEA Section 111 Reporting. Franco Signor is proud to be a founding …
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