Settlement
CMS releases WCMSA Self-Administration Toolkit 1.3
CMS has released the latest edition of its Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (Version 1.3; October 10, 2019).
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,…
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…
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.
PAID Act introduced in the U.S. Senate
On June 26, 2019, Senators Tim Scott (R-SC) and Ben Cardin (D-MD) introduced Senate Bill 1989 into the U.S. Senate.
Medicaid expansion makes recovery efforts more urgent
Within broad federal requirements, states and territories have significant flexibility in program design and administration, resulting in 56 unique Medicaid programs.
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.
Reality check: Debunking the myths of Medicare Secondary Payer compliance
MSP is a challenging area of compliance for which federal law, regulations, and policy don’t always provide clear answers. It’s vital to understand fact vs fiction.
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
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…
Proposed rules for addressing future medical obligations to be released
The Office of Information and Regulatory Affairs (OIRA) recently issued a notice entitled Miscellaneous Medicare Secondary Payer Clarifications and Updates (CMS-6047-P).…
CMS retains $750 “Low Dollar” threshold for 2019
The Centers for Medicare and Medicaid Services (CMS) has released its low dollar recovery threshold for 2019 via an alert dated November 15, 2018. CMS is generally…
Law firm reaches settlement with U.S. Department of Justice to reimburse Medicare conditional payments and start internal MSP compliance program
The United States Department of Justice (DOJ) for the Eastern District of Pennsylvania has issued a news release reporting that a Philadelphia personal injury law firm…
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…