Category Archives: Uncategorized

Uncategorized

Humana is continuing on its mission to establish precedent across the country regarding Medicare Advantage Plans’ (MAPs) ability to pursue a Medicare Secondary Payer (MSP) double damages private cause of action against primary plans that fail to reimburse conditional payments. Just filed is an action by Humana against Bi-Lo, LLC, a grocery retailer, in the U.S. District Court for the …
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Uncategorized

WCRC Transition Webinar to be Held Wednesday, March 7, 2018 at 1:00 PM EST Effective March 19, 2018, Capitol Bridge LLC will take over as the Workers’ Compensation Review Contractor from Provider Resources. On this webinar, CMS will introduce Capitol Bridge with opening remarks and a presentation by CMS, as well as provide a Q&A session for the audience. The …
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In case you missed it!

01 Aug 2017 Jesse Hamby No Comments

Uncategorized

If you were not able to join us for the live webinar event on Monday, July 31st, click here to visit our YouTube channel and check out: Franco Signor Special Webinar Presentation: Analyzing the Newly Announced Medicare Set-Aside (MSA) Amended Review Process

Uncategorized

In MSPA Claims 1, LLC v. Ocean Harbor Casualty Insurance out of the Eleventh Circuit in Miami-Dade County, Florida, a class has been certified by all Florida Medicare Advantage Organizations (MAOs) against a no-fault insurer for failure to provide reimbursement for Medicare Advantage conditional payments by its enrollees. We have previously blogged about other similar litigation by this Plaintiff (link …
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Uncategorized

CMS issued a recent alert (click here) warning Responsible Reporting Entities (RREs) to accurately report ORM and ICD-9/ICD 10 codes. CMS intends that effective January 1, 2016 to use this information from Section 111 data to coordinate benefits for Medicare beneficiaries. This means that injured workers or other no-fault claimants will have Medicare benefits stopped during the period of the …
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Blog, Franco Signor News, Uncategorized

Franco Signor is proud to sponsor the CLM 2015 Insurance Fraud and Workers’ Compensation Conference. This conference will be held in Boston on Thursday, May 7th. “While seemingly unrelated, Workers’ Compensation and Insurance Fraud actually complement each other perfectly. Insurance Fraud can potentially present itself in many aspects of the Workers’ Compensation claim which makes the pairing of these two conferences …
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CMS Improves Information to Better Manage Recoveries

14 Nov 2014 Roy Franco No Comments

Blog, Medicare Reporting Section 111, RRE, Uncategorized

CMS issued a new Technical Alert on November 10, 2014. Click here to read it in its entirety. No action is required by Franco Signor clients. CMS, effective July 1, 2015, will provide RREs with the ability to identify a “Recovery Agent” for conditional payments. To do so, new fields will be added to the MMSEA TIN Reference File, and …
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Uncategorized

The Centers for Medicare & Medicaid Services (CMS) has been deliberate and methodical in actions taken. Program change takes time and more often than not is incremental. We regularly remind clients that it is unwise to draw conclusions from CMS updates without consideration of all its existing and related policies. When evaluated in a vacuum the results can have potentially …
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Suing Medicare Does Not Work. Again.

01 Aug 2013 Jeffrey Santoro No Comments

Blog, Medicare Jurisdiction, Medicare Secondary Payer News, Uncategorized

The USDC for the Southern District of Ohio has confirmed, yet again, that an action against Medicare cannot be commenced until all administrative remedies have been exhausted.  The underlying action resulted from an MVA where the plaintiff was a Medicare beneficiary.  After settlement of the action Medicare sought recovery of its conditional payments for plaintiff’s medical treatment, which were approximately …
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GHP Town Hall Teleconference Notice – August 8, 2013

08 Jul 2013 Jesse Hamby No Comments

Blog, Medicare Secondary Payer News, Uncategorized

The notice and agenda for the GHP Town Hall Teleconference scheduled for August 8, 2013 can be found in the Downloads area of the What’s New page of the Mandatory Insurer Reporting for Group Health Plans section.  The following link may be used to access the section’s main page, http://go.cms.gov/mirghp.  Once on the main page, click the What’s New link on …
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