Category Archives: Legal/Legislative News

Blog, Legal/Legislative News, Medicare Advantage Part C

Hartford Casualty Insurance Company is the target of a new complaint recently filed in the United States District Court, Western District of Washington (Seattle) by Humana Health Plan. Humana, as a Medicare Advantage Plan (MAP) is seeking a declaratory judgment as to Hartford’s obligation to reimburse conditional payments made by Humana, as well as a private cause of action pursuant …
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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, Legal/Legislative News, Medicare Secondary Payer News, WCMSA

The WCRC, the entity which reviews Workers’ Compensation Medicare Set-Asides (WCMSAs) for the Centers for Medicare & Medicaid Services (CMS) has issued the award to Capitol Bridge LLC, a government services firm with its headquarters in Arlington, Virginia. The award notice is as of September 1, 2017 and can be found here. Noteworthy of the award is that it is for …
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About Franco Signor, Blog, Franco Signor News, Legal/Legislative News

Session: Important Medicare & Medicaid Changes Primary Plans Need to Leverage for Savings Friday, September 8th / 9:00 – 10:00 am CMS has been actively pursuing conditional payments for close to a decade where there is a settlement, judgment or award. In the fall of 2015, CMS expanded recoveries to include unresolved cases with Ongoing Responsibility for Medical. Given the …
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Legal/Legislative News, Medicare Jurisdiction, Medicare Set Aside, WCMSA

There are two recent updates which may impact workers’ compensation payers looking to finalize and foreclose future medical expenses and which additionally may impact claims that involve a Medicare Set-Aside (MSA). I. Arizona Passes Bill 1332 Allowing for Full and Final Settlement of Workers’ Compensation Claims Senate Bill 1332, signed into law by Governor Ducey on May 8, 2017 which …
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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 …
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Blog, Legal/Legislative News, Medicare Reporting Section 111

In a decision out of the Superior Court of Connecticut, Silver v. Miliford Medical Center Associates, 2017 Conn. Super. LEXIS 899 (May 11, 2017), a defendant medical provider filed a motion to compel the Plaintiff to respond to supplemental discovery so that its insurer could comply with the requisite requirements of MMSEA Section 111. Essentially, the medical provider’s insurer, which …
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Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Secondary Payer News

During an interview on this past Sunday, President Trump indicated that he does not plan to touch the concept of Medicare; however, he and his administration would be tough on Medicare fraud, waste, and abuse. The timing of this statement by President Trump is coincidental with the United States joining in on a False Claims Act (FCA) whistleblower lawsuit this …
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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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