Category Archives: Legal/Legislative News

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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Administration, Blog, Legal/Legislative News, Medicare Set Aside, WCMSA

For numerous years, a slightly varied version of essentially the same proposed legislation regarding Workers’ Compensation Medicare Set-Asides (WCMSAs) continues to be re-introduced in Congress (hereinafter referred to as “MSA Bill”). Just last week, the MSA Bill was again introduced in the Senate. It is titled “Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2018.” A copy of …
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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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Settlement Contingent Upon CMS Approval of WCMSA: Problematic?

08 May 2018 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Secondary Payer News, WCMSA

A decision just issued out of the Third Circuit Court of Appeal in Louisiana demonstrates the various nuances and obstacles that may be present when entering into a workers’ compensation settlement contingent upon CMS approval of a WCMSA. In Ortega v. Cantu Servs., Inc. 2018 La. App. LEXIS 845 (May 2, 2018), the claimant, a Medicare beneficiary, settled her disputed …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Trial Practice

The U.S. District Court for the Southern District of Texas has issued an opinion in ongoing litigation by Aetna and Humana, both Medicare Advantage Plans (MAPs), against a Plaintiff law firm that represented asbestos trusts. The allegation by Aetna and Humana (“Plaintiffs”) is that Defendant Shrader Associates LLP (“Schrader”) represented at least fifteen “Matched claimants” that received coverage from the …
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Blog, Legal/Legislative News, Medicare Advantage Part C

Primary Plans Beware: The tide continues to turn across the country in favor of Medicare Advantage Plans (MAPs) having a right to sue primary plans based on the Medicare Secondary Payer (MSP) private cause of action and the ability to seek double damages for the failure to reimburse MAP conditional payments. The decision has the potential to extend the law …
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Blog, Legal/Legislative News, Medicare Advantage Part C

Previously, we blogged on the “System” created by MSP Recovery LLC to identify potential primary payers in Medicare Advantage Plan (MAO) conditional payment recovery claims.  The Plaintiff, MSP Recovery LLC, testified that they created this unique “System” using the following databases; ISO reports, state car crash databases, MAO claim data, and others.  MSP Recovery has now secured a preliminary $5M settlement in court …
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CMS Releases Updated NGHP User Guide Version 5.3

27 Dec 2017 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Conditional Payments, Medicare Reporting Section 111, Medicare Secondary Payer News

CMS has released an updated Non-Group Health Plan (NGHP) User Guide version 5.3. It can be found here. The primary change to the User Guide involves detailing CMS’ transition with its Social Security Number Removal Initiative (SSNRI) and how this transition will impact MMSEA Section 111 Reporting. The SSNRI initiative mandates CMS to replace all SSN-based Medicare identifiers and distribute a …
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