Medicare Set Aside Protocol in the WDNY

06 May 2011 Jeff Signor No Comments

Blog, Medicare Reporting Section 111, Medicare Set Aside, WCMSA

Today I had the honor of presenting on the topic of Medicare Secondary Payor Compliance with Robert Trusiak, Esq, Assistant US Attorney for the Western District of New York.  We presented at the headquarters of the Erie County Bar Association, and the presentation was sponsored by the Western New York Chapter of the Women’s Bar Association.  The protocol is set …
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Obtaining Jurisdiction Against CMS Is Difficult

27 Apr 2011 Roy Franco No Comments

Blog, Uncategorized

A common reaction we see from litigators when first exposed to Medicare is to resort to litigation against the Centers for Medicare & Medicaid Services (CMS). This particular agency is part of the Health & Human Services Department and it is charged with the administration of the Medicare Trust Fund.  CMS  is the logical target to haul into state court to resolve …
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Blog, Trial Practice

The Medicare Secondary Payer law creates contingent liabilities for the insurance company or self insurance plan settling a liability or workers’ compensation claim. One way to mitigate against those liabilities is to settle a claim based on certain conditions. In several cases our office has blogged about, courts have been reluctant to support these pre-conditions unless there was a clear …
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Blog, Medicare Jurisdiction

A recent decision demonstrates the futility of using the courts to establish what is owed Medicare in an ongoing liability or workers’ compensation claim. In this particular situation, plaintiff filed a state court proceeding to recover for injuries she sustained due to an automobile accident. Her lawyers also filed, as part of that state action, a third party complaint against …
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Allocation, Blog, Medicare Conditional Payments

In 1980, Congress passed the Medicare Secondary Payer Act (MSP) in response to a dramatic increase in Medicare expenditures. See Baptist Mem’l Hosp. v. Pan Am. Life Ins. Co., 45 F.3d 992, 997 (6th Cir. 1995). In doing so, it constructed this law with several safeguards to protect the integrity of the Medicare Trust Fund. One of these is the …
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Allocation, Blog, Medicare Conditional Payments

If decedent is a Medicare beneficiary, be thoughtful about preparing for the related wrongful death action claim.  Medicare most likely will be entitled to reimbursement for the decedent’s related medical expense if there is a settlement, judgment or award.  The wrongful death claimants are not protected from Medicare’s reach, but practitioners may seek refuge through proper planning. Segregate the claims …
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