Medicare Advantage Plan (MAP)

3/20/2017 - 8 min read

2017 Medicare watch list

It’s clear there will be no shortage of Medicare Secondary Payer developments to keep an eye on this year. Here’s an outline of MSP events to watch in 2017.

11/11/2016 - 4 min read

Removing roadblocks to settlements: Medicare Part C claims in the way of your settlement

The last half-dozen years have seen Medicare Secondary Payer (MSP) compliance evolve, with the most recent example being its change in focus from mandatory insurer reporting to rolling recovery.

9/29/2016 - 3 min read

The SPARC Act may have implications for future Medicare Advantage Plan rulings

On September 22, Congressmen Tim Murphy (R-PA) and Ron Kind (D-WI) introduced legislation designed to clarify the Medicare Secondary Payer (MSP).

9/8/2016 - 3 min read

Medicare Advantage Plans allowed to sue no-fault carriers for private cause of action

New ruling likely to lead to more MAP lien claims against PIP insurers.

8/19/2016 - 4 min read

Preparing for a fundamental compliance shift in liability claims

Liability claims are particularly at risk, as these emerging compliance issues impose new burdens on the management and settlement of claims.

8/18/2016 - 4 min read

MSP statute extends its reach in the 11th Circuit: Foreshadowing for liability MSAs?

Undoubtedly, the 11th Circuit Court decision in Humana has obvious financial consequences to insurers.

8/17/2016 - 4 min read

The impact of Medicare Advantage Plans on your claims: The risk of double damages and summary judgment

The decision will have a significant impact on liability, workers compensation, and no-fault claims being handled.

8/12/2016 - 5 min read

Breaking news: 11th Circuit rules Medicare Advantage Plans can sue in federal court

The Eleventh Circuit Court of Appeals expanded the rights of Medicare Advantage Organizations (MAOs) to use federal court to sue primary payers.

6/21/2016 - 4 min read

New front in Medicare Advantage battle: Law firm targeted

We continue to watch closely the expansion of Medicare Secondary Payer (MSP) recovery concepts to cases involving Medicare Advantage Plans (MAPs).

7/29/2015 - 1 min read

Employee spotlight: Walter Johnson

With Medicare recovery issues a top priority for our clients, we’d like to introduce you to Walter Johnson, our senior lien analyst.

4/15/2015 - 4 min read

Medicare Advantage strikes again: Humana v. Western Heritage

The last few years have seen several key cases regarding the evolving issue of what rights Medicare Advantage organizations (MAOs) have when seeking recovery in a primary payer situation. In particular, MAOs are increasingly seeking federal court — and the Medicare Secondary Payer (MSP) statute’s double damages provision — as the means to recover.

1/13/2015 - 12 min read

Court: Medicare Advantage Organization can pursue reimbursement against its enrollee

In an important new Medicare Advantage case, the court in Collins v. Wellcare Healthcare Plans, Inc., No. 13-6759, 2014 WL 7239426 (E.D. La December 16, 2014) ruled that a Medicare Advantage Organization (MAO) had private cause of action rights under the Medicare Secondary Payer (MSP) statute thereby allowing it to pursue a reimbursement claim against its enrollee.

12/17/2014 - 6 min read

Medicare Advantage update: Court rejects Humana’s request for class certification

In the case In re Avandia, MDL No. 1871, 2014 WL 6684343 (E.D. Pennsylvania, Nov. 24, 2014),1 the United States District Court denied Humana’s request for class certification regarding those Medicare Advantage Plans (MAP) with unresolved lien recovery claims.

10/14/2014 - 2 min read

Court allows Medicare Advantage plan’s suit for double damages to proceed

In an important development on the Medicare Advantage (MA) front, the court in Humana v. Farmers Texas County Mutual Insurance Company, et. al, No. 13-CV-611-LY (W.D. Texas, September 24, 2014) issued a ruling allowing a Medicare Advantage plan’s lawsuit for “double damages” to proceed.