Medicare Secondary Payer (MSP)

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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.

12/9/2019 - 1 min read

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.

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.

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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10/3/2019 - 9 min read

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 Medicare Secondary Payer’s (MSP’s) private cause of action (PCA) statute.

8/21/2019 - 6 min read

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 standing grounds.

8/12/2019 - 2 min read

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.

7/26/2019 - 9 min read

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.

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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.

6/17/2019 - 8 min read

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.

5/17/2019 - 5 min read

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 obligations

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.

3/14/2019 - 2 min read

CMS holds webinar to address plans to add electronic payment functionality to its Medicare Secondary Payer Recovery Portal

On 3/13/19, CMS held a webinar to discuss its plans to add electronic payment functionality to its Medicare Secondary Payer Recovery Portal.