Mark Popolizio, J.D.
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…
The new indemnity data call – are you ready?
The NCCI new indemnity data call initiative is scheduled to launch in Q2 of 2020, with the certification and testing process slated to begin in Q1 of 2020.
Seventh Circuit bypasses Medicare Advantage “double damages” question
The Seventh Circuit affirmed (with modification) a ruling from the U.S. District Court for the Central District of Illinois dismissing a MAP assignee’s PCA claim on…
Release of proposed “future medicals” rules will be delayed
CMS’s release of proposed rules to address “future medicals” in relation to non-group health plan settlements will be delayed from Sept. 2019 to Oct. 2019.
WCMSA RX update – FDA approves first generics of Lyrica
On 7/22/19, the FDA announced it approved the first generics of Lyrica. This comes at a critical time as CMS has increasingly been including Lyrica in WCMSAs
Massachusetts court: Medicare Advantage Plan’s assignee can sue for “double damages” under the MSP
Massachusetts is the latest jurisdiction to take a favorable view of MAPs possessing private cause of action rights under the Medicare Secondary Payer.
CMS releases new NGHP Section 111 user guide (Version 5.6)
On 7/1/19, CMS released an updated Section 111 User Guide (Version 5.6) regarding non-group health plans (liability, no-fault and workers’ compensation).
Big reforms are coming to Michigan PIP - How the changes will impact Medicare Secondary Payer compliance
On 5/30/19, Governor Gretchen Whitmer signed Michigan Senate Bill 1, which makes significant changes to Michigan’s personal injury protection (PIP) system.
Florida court: No-fault pre-suit notice requirement must be followed before Medicare private cause of action claim can proceed
In a new Florida decision, the U.S. District Court in ruled Florida’s no-fault pre-suit notice requirement must be satisfied before a PCA action can proceed.
Longshore Act - Medicare alert: Court rules that claimant’s action for “double damages” was premature
Claims payers pursuant to the Longshore Act need to stay vigilant for potential double damages actions under the MSP statute’s private cause of action provision
Developing a Medicare Game Plan: Meeting the MSP Challenge
Medicare Secondary Payer (MSP) compliance continues to present challenges to claims departments.
Maryland law firm reaches $250,000 settlement with U.S. Department of Justice to reimburse Medicare conditional payments
A Maryland personal injury law firm settled for $250,000 with the U.S. to resolve allegations it failed to reimburse certain Medicare payments made to medical providers…