Mark Popolizio
CMS releases new NGHP Section 111 User Guide (Version 5.8)
CMS has released an updated Section 111 User Guide (Version 5.8, January 31, 2020) regarding non-group health plans (liability, no-fault and workers’ compensation).
California spotlight: Medicare Advantage recovery rights
The issue of Medicare Advantage Plans recovery rights has catapulted to the compliance forefront over the past few years following a series of court rulings finding that…
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…
Ohio court rules that Medicare Advantage Plans can sue insurers for “double damages” under the MSP
The U.S. District Court in Ohio ruled MAPs can sue insurers for “double damages” under the MSP and the three-year claims filing period doesn’t create a statutory…
CMS to host town hall meeting to discuss CRC ORM recovery issues related to NGHP claims
CMS announced it will host a town hall meeting on recovery issues related to the CRC and on-going responsibility for medicals for non-group health claims.
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), the United States District Court for the Central District of Illinois found that an…
CMS retains its $750 “Low Dollar” threshold for 2020
CMS announced it is retaining its current $750 low dollar threshold in 2020.
CMS’s expected release of its “future medicals” (LMSA) proposals delayed until February 2020
OIRA announced CMS’s expected release of its Notice of Proposed Rulemaking (NPRM) proposals for “future medicals” has been pushed back to February 2020.
Release of CMS’s Section 111 penalty proposals delayed again – pushed back to December
OIRA announced CMS’s expected release of its Notice of Proposed Rulemaking proposals for Section 111 civil money penalties has been pushed to December 2019.
CMS’s new Section 111 alert addresses MBI reporting
CMS has issued an updated Section 111 Alert pertaining to non-group health claims (NGHP) regarding the Medicare Beneficiary Identifier (MBI) reporting.
Liability Medicare Set Asides – Bracing for the storm
Liability claims payers have been left to navigate the uncertainties around LMSA’s the best they can while preparing for where CMS may be heading next.
CMS releases new WCMSA Reference Guide (Version 3.0)
CMS has released a revised Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide (Version 3.0, October 10, 2019).
CMS releases new NGHP Section 111 user guide (Version 5.7)
On 10/7/19, CMS released an updated Section 111 User Guide (Version 5.7) regarding non-group health plans (liability, no-fault and workers’ compensation).
Ninth Circuit: CIGA is not a “primary payer” under the MSP and does not have to reimburse Medicare
In a significant new case out of California, the United States Circuit Court of Appeals (Ninth Circuit)[1] in California Insurance Guarantee Association (CIGA) v. Azar,…
South Carolina court: Medicare Advantage Plan can sue for “double damages” under the Medicare Secondary Payer statute
The South Carolina District Court is the latest jurisdiction presented with the question of whether a Medicare Advantage Plan (MAP) can sue for “double damages” under the…