VISUALIZE | INSIGHTS THAT POWER INNOVATION

Mark Popolizio

Mark Popolizio, J.D., is vice president of MSP compliance at ISO Claims Partners, a Verisk business. You can contact Mark at mpopolizio@verisk.com.

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February 12, 2020

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).

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February 12, 2020

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…

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January 10, 2020

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…

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December 17, 2019

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…

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December 9, 2019

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.

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December 5, 2019

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…

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December 2, 2019

CMS retains its $750 “Low Dollar” threshold for 2020

CMS announced it is retaining its current $750 low dollar threshold in 2020.

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November 22, 2019

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.

Proposal
November 21, 2019

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.

Reports
November 20, 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.

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November 13, 2019

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.

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October 31, 2019

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).

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October 23, 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).

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October 11, 2019

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,…

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October 3, 2019

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…