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Medicare Secondary Payer (MSP)

June 8, 2018

Court denies “double damages” under the MSP’s private cause of action

Currently, there are two questions being litigated that involve who can sue under the Medicare Secondary Payer’s (MSP) private cause of action (PCA) provision and when…

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March 19, 2018

Medicare Advantage update: Connecticut court rules MAPs can pursue “double damages” under the Medicare Secondary Payer statute

Connecticut is the latest jurisdiction to address whether MAPs have private cause of action (PCA) rights to pursue “double damages” under the MSP statute.

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February 28, 2018

Medicare watch list: Staying ahead of the Medicare Secondary Payer compliance curve

As another new year settles in, we know at least one thing is certain: MSP compliance will continue to present formidable challenges for claims payers.

January 23, 2018

Government shutdown ends – Congress and President reach deal

This brief government shutdown did not affect Medicare Secondary Payer operations as they are essential and considered part of the Medicare Integrity Program. Thus,…

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January 22, 2018

Government shutdown & Medicare Secondary Payer impact

Medicare Secondary Payer operations will not be affected as they are essential and considered part of the Medicare Integrity Program. However, were are receiving word…

January 12, 2018

Medicare Advantage Plans update: Illinois court indicates MAPs have “double damages” rights

Whether Medicare Advantage Plans have private cause of action rights to sue claims payers (and others) for “double damages” under the Medicare Secondary Payer (MSP)…

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December 21, 2017

CMS Releases New Section 111 NGHP User Guide (Version 5.3)

The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 non-group health plan (NGHP) User Guide (Version 5.3, December 15, 2017).

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November 27, 2017

Medicare Part D - The next recovery frontier?

Spurred by a number of favorable court decisions allowing MAPs to sue for “double damages” under the MSP statute, Medicare Part D plans are now beginning to step into the…

October 26, 2017

Liability MSA update

On October 26, 2017, the Centers for Medicare and Medicaid Services (CMS) has released its latest update regarding the LMSA issue.

October 6, 2017

Performant awarded CMS Commercial Repayment Center contract

The Centers for Medicare and Medicaid Services (CMS) awarded Performant Financial Corporation (Performant) the Commercial Repayment Center (CRC) contract.

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September 26, 2017

Countdown to “full and final” settlements: Arizona S.B. 1332

The recent passage of Arizona Senate Bill (S.B.) 1332 provides Arizona claims payers with unprecedented opportunity to close out their workers' comp claims.

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June 16, 2017

Court blocks Medicare discovery requests - Ruling limits insurer's ability to determine MMSEA obligations

A new case out of Connecticut highlights complications insurers can encounter in obtaining information to assess their MSP compliance obligations.

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May 22, 2017

New realities: The Section 111 connection to conditional payments and claim outcomes

Section 111 reporting used to be viewed as an abstract technical Medicare compliance obligation & IT's responsibility because of the data transmission.

May 17, 2017

Risky business: Five essential tips for Section 111 reporting

Your Section 111 reporting program may seem clear-cut, but it can mean risky business if your team isn’t prepared to avoid common compliance mistakes.

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April 26, 2017

Exhaust administrative remedies before challenging Medicare conditional payment claims

When challenging Medicare conditional payment claims, parties must exhaust Medicare administrative appeals before filing an action in federal court.

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