Medicare Secondary Payer (MSP)
CMS’s Section 111 penalty proposals are here
CMS has released its long-awaited Section 111 civil money penalty proposals for non-group health plans, as well as group health plans.
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.
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…
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,…
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…
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…
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.
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.
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.
With civil money penalties looming, it’s time to fine-tune CMS reporting
Steering clear of CMS penalties is possible by implementing a meticulous query process and being mindful of the regulations surrounding ongoing medicals and total payment…