Medicare Secondary Payer (MSP)

CMS holds town hall call to discuss NGHP conditional payment recovery issues

On January 14, 2020, the Centers for Medicare and Medicaid Services (CMS) held its widely anticipated town hall call to discuss recovery issues related to the Commercial Repayment Center (CRC) and on-going...

Philadelphia law firm reaches settlement with U.S. Department of Justice regarding alleged failure to resolve Medicare conditional payments

The United States Department of Justice (DOJ), United States Attorney’s Office for the Eastern District of Pennsylvania has issued a  news release reporting that a Philadelphia personal injury law firm has entered int...

Ohio court rules that Medicare Advantage Plans can sue insurers for “double damages” under the MSP

The United States District Court for the Northern District of Ohio is the latest court to weigh-in regarding the ongoing issues and questions concerning the applicability of the Medicare Secondary Payer (MSP) statute’...

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...

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...

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...

Medicare Part D - The Next Recovery Frontier?

Medicare Secondary Payer (MSP) compliance has historically focused on the interests of traditional Medicare (that is, Medicare Parts A and B). In the wake of the recent In Re Avandia decision out of the United States...

Eye on the courts: Florida’s collateral source rule does not apply to future Medicare payments

In an interesting new case in Florida, the court was called upon to address whether and how a plaintiff’s Medicare benefits should be considered in terms of evidence presented at trial. In Joerg v. State Farm Mutual...

ICD-10 Codes Adoption

On April 1, 2014, President Obama signed the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93). The act stated that International Classification of Diseases-10 (ICD-10) adoption would not occur...

CMS Update: User Meetings, GAO Report, and Recertification Requirement

Here are updates on some topics you should know about if your company is required to report bodily injury claims to the Centers for Medicare and Medicaid Services (CMS). Medicare Secondary Payer Reporting Service User...