Blog, Medicare Jurisdiction

Filing a lawsuit against Medicare to adjudicate the reimbursement claim owed under the Medicare Secondary Payer Act (MSP) requires navigation of a labyrinth of steps before it will be accepted by a Court. The starting point is a determination by Medicare of what it is owed which usually comes in the form of a Final Demand Letter from its contractor, …
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When to Use a Liability Medicare Set-Aside (LMSA)

30 May 2011 Roy Franco No Comments

Blog, LMSA, Medicare Set Aside

The Centers for Medicare & Medicaid Services (CMS) has put the insurance industry on high alert. Threat of penalties for failure to report liability claims involving a Medicare beneficiary has raised concerns over properly meeting obligations owed Medicare. One particular question has raised great controversy – Does a settlement, judgment, award, or other payment to a Medicare beneficiary need to …
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Blog, LMSA, Medicare Set Aside

Claimant became a Medicare beneficiary as a result of injuries she sustained in an accident. Her attorney contacted Medicare to determine the amount of the conditional payment, but found nothing was owed. Concerned that Medicare may make payments in the future that are related to the incident in question, the attorney made sure to create a system to prevent this …
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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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