Conditional Payments

3/6/2020 - 2 min read

CMS releases town hall question/answer document

The Centers for Medicare and Medicaid Services (CMS) has released a question/answer document in follow up to its January 14, 2010 town hall call.

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2/27/2020 - 14 min read

The Eleventh Circuit rules that the MSP’s three-year “claims-filing” statute is not a prerequisite for filing a private cause of action recovery claim

In reversing a lower court decision, the U.S. Circuit Court of Appeals (Eleventh Circuit) in MSPA Claims 1, LLC v. Kingsway Amigo Insurance ruled compliance with the Medicare Secondary Payer’s “claims-filing” statute was not a prerequisite for filing a private cause of action recovery claim.

2/12/2020 - 21 min read

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 MAPs can sue claims payers for “double damages” under the Medicare Secondary Payer private cause of action provision.

1/21/2020 - 7 min read

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

On 1/14/20, CMS held a call to discuss recovery issues related to the Commercial Repayment Center and on-going responsibility for medicals with respect to non-group health claims (e.g., liability, self-insurance, no-fault, workers’ compensation, etc.).

1/10/2020 - 6 min read

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 into a settlement for $6,604.59 with the United States to resolve allegations that it failed to reimburse certain Medicare payments made to medical providers on behalf of the firm’s clients.

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12/17/2019 - 16 min read

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.

12/5/2019 - 11 min read

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 assignee of a Medicare Advantage Plan (MAP) failed to allege sufficient facts to establish standing to pursue a private cause of action (PCA) claim for “double damages” against the defendant no-fault insurer under the Medicare Secondary Payer (MSP) statute.

12/2/2019 - 4 min read

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

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

10/11/2019 - 8 min read

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, 2019 WL 5076945 (9th Cir. Oct. 10, 2019) reversed the United States District Court for the Central District Court of California [2] and ruled that CIGA is not a “primary plan” under the Medicare Secondary Payer (MSP) statute and, therefore, not liable to reimburse Medicare conditional payments made on behalf of workers’ compensation claimants.

10/7/2019 - 7 min read

Conditional payment updates | Open Debt Reports are back; Pre-PCN worksheets are on hold; and CRC will continue to review all CPL disputes

There has been a flurry of recent activity from the Centers for Medicare and Medicaid Services (CMS) and the Commercial Repayment Center (CRC) regarding processing of conditional payment claims.

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8/22/2019 - 4 min read

CRC looks to resolve backload of conditional payment leads

On 8/9/19, the Commercial Repayment Center hosted a conference call to discuss the handling of conditional payment letters versus conditional payment notices.

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6/17/2019 - 6 min read

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.

4/24/2019 - 7 min read

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

3/21/2019 - 4 min read

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 on behalf of a firm client.

12/20/2018 - 3 min read

MSPRP update: CMS announces a new self-reporting option and updates to the multi-factor authentication process

The Centers for Medicare and Medicaid Services (CMS) hosted a webinar focusing on enhancements to its Medicare Secondary Payer Recovery Portal (MSPRP) on December 18, 2018.