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Medicare Advantage Plan (MAP)

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March 10, 2021

PAID Act – current status and FAQs

At this time, the industry is waiting for CMS to release its PAID Act implementation plan, which will require yet to be released technical updates to its Section 111…

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December 14, 2020

The PAID Act is now law

On 12/11, the PAID Act became law. It requires CMS expand its Section 111 Query Process to identify whether a claimant is currently entitled to, or during the preceding…

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December 9, 2020

PAID Act passes House, moves to the Senate

On 12/8, the House of Representatives passed the PAID Act as a stand-alone bill and as part of the BENES Act of 2019. Both bills now move to the Senate for further…

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September 10, 2020

11th Circuit rules Medicare Advantage downstream entities can sue for double damages under MSP’s PCA provision

The 11th Circuit has ruled “downstream entities”, which Medicare Advantage Plans contract with to help provide benefits, can sue primary plans for “double damages.”

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August 20, 2020

What’s up in D.C.? Medicare Secondary Payer reform efforts – status update

With the current Congressional session ending on 1/3/21, attention is on two pending Medicare Secondary Payer reform efforts: The PAID Act & the COMP Act.

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August 7, 2020

Connecticut court rules Medicare Advantage Plan entitled to double damages

The U.S. District Court for Connecticut in Aetna v. Guerrera, 2020 ruled, in part, the alleged self-insured supermarket was a primary plan and liable for “double damages”…

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July 8, 2020

Seven steps to closed: Maximizing claims settlement projects

There's a thin and potentially costly line between settling a claim and keeping it open. Using a claims settlement project can help close claims faster.

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March 6, 2020

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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February 27, 2020

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…

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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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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 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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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…

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August 21, 2019

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…

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July 26, 2019

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.