Category Archives: Medicare Advantage Part C

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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Blog, Medicare Advantage Part C

Last week, the National Association of Medicare Set Aside Professionals (NAMSAP) held their annual conference in San Antonio, Texas.  Personally, I was quite excited about the meeting and decided to attend because Judge Lee Yeakel, Judge, U.S. District Court (TX, Western District) would be speaking.   It is rare to hear from a Judge sitting on the Federal bench about his insights …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Trial Practice

Medicare Advantage Plans have set their sights on a new target for the MSP Private Cause of Action: Plaintiff attorneys representing Medicare beneficiaries. We have previously only seen these causes of action against insurance companies, self-insureds and providers. In an opinion out of the U.S. District Court for the Eastern District of Virginia, Humana v. Paris Blank LLP, 2016 U.S. …
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Blog, Medicare Advantage Part C, Medicare Jurisdiction, Trial Practice

Infuse bone graft is FDA approved for certain spinal fusion procedures.  In 2002, Humana agreed to reimburse their insureds for off-label use in reliance on Medtronics’ medical literature that touted the benefits of the infuse product while underreporting its adverse effects.  Humana reversed this policy in February 2009 based on medical literature that questioned the safety and efficacy of Infuse …
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Blog, Medicare Advantage Part C, Medicare Conditional Payments

In an opinion out of the United States District Court for the Eastern District of Tennessee, Cariten Health Plan, Inc. v. Mid-Century Insurance Company, 2015 U.S. Dist. LEXIS 126887 (September 1, 2015 decided; September 24, 2015 published), we have another example where a Medicare Advantage Plan (MAP) has sought to establish its right to an MSP private cause of action …
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More MSP Private Cause of Action “Action”

02 Sep 2015 Heather Sanderson No Comments

Blog, Medicare Advantage Part C, Medicare Jurisdiction, Medicare Secondary Payer News, Medicare Set Aside

A new opinion was just released out of the U.S. District Court for the Southern District of Florida, MSPA Claims 1, LLC v. IDS Property Casualty Insurance Company (August 28, 2015). This case involved MSPA Claims 1, LLC (“MSPA Claims”), as an assignee and on behalf of Florida Healthcare Plus (FHCP), a Medicare Advantage Plan (MAP), pursuing Property Casualty Insurance …
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MSP Medicare Advantage Plan Recovery Rights Case Law Rampant

03 Aug 2015 Heather Sanderson No Comments

Blog, Medicare Advantage Part C

The Medicare Advantage Plan (MAP) system continues to grow; according to the Kaiser Family Foundation, as much as 31% of the Medicare population in the United States is also enrolled in a Medicare Advantage Plan. Recently, we have seen a great deal of case law where courts have had the difficult to task in deciphering whether MAPs and MAP beneficiaries …
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Blog, Medicare Advantage Part C

In a recently argued claim before the North Carolina Industrial Commission, Wallace v. National Vision, 2015 WL 3745634 (June 9, 2015), the parties had to resolve a Medicare Advantage (MAO) reimbursement claim in a disputed case. The injured worker was a MAO beneficiary. The MAO incurred expenses for the industrial accident because medical treatment was denied by her employer’s plan.   …
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Blog, Medicare Advantage Part C

The 31 page written decision by U.S. Federal District Court Judge Eldon Fallon advances Medicare Advantage Organizations (MAOs) on a number of fronts.  This 5th Circuit opinion in Amie Collins v. Wellcare Plans, Inc. from the Eastern District of Louisiana makes a number of key findings for Parties to consider when resolving tort claims that involve payment for medical items …
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Blog, Medicare Advantage Part C, Medicare Secondary Payer News

The state appellate court in Arizona considered the issue of preemption regarding Medicare Advantage Plans: Does Part C of the Medicare Act and its associated regulations preempt Arizona’s anti-subrogation doctrine?  The court held in the  affirmative, and ruled that a Medicare Advantage Plan (MAP) may seek reimbursement for medical expenses it paid for one of its enrollees from the settlement …
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