Medicare Secondary Payer (MSP)

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3/30/2020 - 4 min read

Social Security Administration suspends processing of third-party requests to determine SSDI status

As of 3/17/20, all the Social Security Administration field offices have been closed to the public in response to the growing COVID-19 pandemic according to its website. Despite the closures, the SSA remains functional.

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.

2/18/2020 - 12 min read

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.

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.

1/10/2020 - 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.

12/9/2019 - 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.