Blog, Medicare Conditional Payments, Reimbursements

The liability industry is getting mixed-signals when it comes to achieving finality to a personal injury claim involving a Medicare beneficiary. The Bradley decision may make practical sense, but it is limited in its application: it does not apply to allocation between damage elements of a settlement fund involving a Medicare beneficiary. That issue will be determined in the case of Hadden v. U.S., recently argued in the 6th Circuit Court of Appeals. A broad extension of Bradley to all Medicare beneficiary cases goes against dozens of cases across the country. However, it may have applicability to any common fund settlement. These would include cases with derivative causes of action like loss of consortium or any mass tort situation. Bradley at least for the 11th Circuit could be used to allocate damages between Medicare and non-Medicare beneficiaries to remove some of the dead lock in settlement distributions.

Franco Signor LLC continues to assist its clients with navigation of the MSP maze. Section 111 reporting goes live on January 1, 2011 retroactive to
October 1, 2010 — All Responsible Reporting Entities (primary plans, defendants, insurers, self-insureds) must now capture the data required to report settlements, judgments or awards exceeding $5,000. As our blog demonstrates, we are carefully following all court decisions and CMS guidance in order to provide timely and informed advice to our growing client base. Allow us to assist you on this important topic!

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Seeking Jurisdiction against Medicare

28 Sep 2010 Roy Franco No Comments

Blog, Medicare Jurisdiction

Commencing litigation against Medicare is difficult.  As a Federal entity, sovereign immunity usually precludes jurisdiction.  Moreover, Congress further insulated Medicare by passing legislation requiring claimants to first exhaust administrative remedies before allowing a case to proceed to Federal court.  See 28 U.S.C. 1331.  Consequently, it could take years before a case is brought before the court and any precedent established.  …
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Blog, Medicare Conditional Payments, Reimbursements

Those of us who regularly handle claims involving Medicare beneficiaries are closely following Hadden v. U.S., 2009 U.S. Dist. LEXIS 69383. Medicare will not adjust its demand based on fault or other defenses to the case, and Medicare will always demand 100% of the services it provides. This is the principle laid out in the lower court of Hadden; but …
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Blog, Medicare Reporting Section 111, RRE

Seger v. Tank Connection, LLC, Docket No. 8:08CV75 (D.Neb. 2010) is less than a few months old but is already having an impact on at least one State Court ruling regarding disclosure to insurance carriers and defendants of plaintiff’s private information. New reporting requirements created by Pub. L. No. 110-73, codified under 42 USC §1395y(b)(8), have established penalties against insurance …
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CMS Issues New Section 111 NGHP User Guide

27 Jul 2010 Roy Franco No Comments

Blog, Medicare Reporting Section 111, Medicare Secondary Payer News, RRE

Version 3.1 of the new NGHP user guide, dated 07/12/2010 was issued this past week by CMS.  Click here for the updated User Guide. Changes from the previously issued version (3.0) may be found at Section 1, starting at page 6. Here are some of the more important highlights for consideration as well as related commentary. 1. Section 7.1 of the …
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Allocation, Blog, Medicare Conditional Payments

The Medicare Secondary Payer Act (MSP) was passed 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 the MSP statute Congress made Medicare coverage secondary to any coverage provided by private insurance [and self insureds] programs. It did so in order to …
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