Compliance

Illinois court dismisses Medicare Advantage Plan suit for “double damages” on standing grounds

In MAO-MSO Recovery II, LLC v. State Farm , 2019 WL 6311987 (C.D. Ill. Nov. 25, 2019), [1] the United States District Court for the Central District of Illinois found that an assignee of a Medicare Advantage Plan (MAP...

Release of CMS’s Section 111 penalty proposals delayed again – pushed back to December

The Office of Information and Regulatory Affairs (OIRA) has issued an updated notice indicating that the Centers for Medicare and Medicaid Services’ (CMS) expected release of its Notice of Proposed Rulemaking (NPRM)...

CMS’s new Section 111 Alert addresses MBI reporting

The Centers for Medicare and Medicaid Services (CMS) has issued an updated Section 111 Alert pertaining to non-group health claims (NGHP) regarding the Medicare Beneficiary Identifier (MBI) reporting.    Through CMS’s...

CMS releases new NGHP Section 111 User Guide (Version 5.7)

The Centers for Medicare and Medicaid Services (CMS) has released an updated  Section 111 User Guide (Version 5.7, October 7, 2019)   regarding non-group health plans (liability, no-fault and workers’ compensation)....

Conditional Payment Updates | Open Debt Reports are back; Pre-PCN worksheets are on hold; and CRC will continue to review all CPL disputes

There has been a flurry of recent activity from the Centers for Medicare and Medicaid Services (CMS) and the Commercial Repayment Center (CRC) regarding processing of conditional payment claims.  The new CMS and CRC...

The new indemnity data call – are you ready?

As the fourth quarter settles in, a big change is lurking around the corner: The National Council on Compensation Insurance’s (NCCI) new indemnity data call.  Introduced last year, this initiative is scheduled to laun...

Seventh Circuit bypasses Medicare Advantage “double damages” question

The latest case addressing whether the Medicare Secondary Payer’s (MSP) private cause of action (PCA) statute [1] applies to Medicare Advantage Plans (MAP), thereby allowing MAPs to sue for double damages,” reached th...

Massachusetts court: Medicare Advantage Plan’s assignee can sue for “double damages” under the MSP

In an interesting new case out of Massachusetts, the United States District Court in MSP Recovery Claims Series LLC v. Plymouth Rock Assurance Corporation , 2019 WL 3239277 (D. Massachusetts, July 18, 2019) found that...

CMS releases new NGHP Section 111 User Guide (Version 5.6)

The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 User Guide (Version 5.6, July 1, 2019 ) regarding non-group health plans (liability, no-fault and workers’ compensation). This...

Law Firm Reaches Settlement with U.S. Department of Justice to Reimburse Medicare Conditional Payments and Start Internal MSP Compliance Program

The United States Department of Justice (DOJ) for the Eastern District of Pennsylvania has issued a news release reporting that a Philadelphia personal injury law firm has agreed to pay the government $28,000.00 to...