Clik here to view.
CMS Relies on Plaintiffs’ Failure to Exhaust Administrative Remedies to...
Several very recent cases confirm the government’s resistance to have the conditional payment responsibility resolved through any means other than those it selects. All of the decisions involved the...
View ArticleClik here to view.
Tracking the SMART Act
Recently, Congressmen Tim Murphy (R-PA) and Ronald Kind (D-WI) introduced HR 1063, a bill titled the “Strengthening Medicare And Repaying Taxpayers Act of 2011.” This piece of legislation, known as...
View ArticleClik here to view.
Haro v. Sebelius, CV 09-134 TUC DCB, (D. AZ.)(May 5, 2011)
On May 5, 2011, a federal judge in Arizona dealt a blow to the routine collection practices of CMS following liability settlements. The Haro v. Sebelius suit was filed by two Medicare beneficiaries...
View ArticleClik here to view.
Handling MSP issues during the CMS Suspension
Many insurers and self-insureds are asking how to manage the repercussions of CMS’ decision to temporarily suspend issuing “Rights and Responsibilities” (RAR) letters and recovery Demand Letters. Here...
View ArticleClik here to view.
Now Available: Non-Group Health Plan User Guide
The long awaited revision to the Non-Group Health Plan User Guide is finally available. CMS Issued Version 3.2 of the NGHP User Guide on August 17, 2011. It can be found on the CMS website. To find...
View ArticleClik here to view.
MSPRC Announces $300 Threshold for Liability Settlements
On September 6, 2011, the Medicare Secondary Payer Recovery Contractor (MSPRC) announced through its website that Medicare has implemented a $300 threshold for certain liability insurance cases. This...
View ArticleClik here to view.
50 Years for $205 Million Health Fraud
Federal courts in Florida have finally learned what is needed to cut into Medicare Fraud, long prison sentences to those convicted of stealing from Medicare. Lawrence Duran, 49, the owner of...
View ArticleClik here to view.
MSPRC ANNOUNCES A NEW SERVICE
On September 23, 2011 the MSPRC announced that it would be adding a Self Service Information Feature to its current Customer Service Line that will provide automated conditional payment information...
View ArticleClik here to view.
Section 111 Medicare Secondary Payer Reporting Update
CMS Announcements on Fixed Percentage Option for Settlements of $5,000 or less, $300 Threshold Limit for Reimbursement, and Identification of Contractor for Medicare Secondary Payer RecoveryThe Centers...
View ArticleClik here to view.
Unveiling the Medical Records Plaintiff Does Not Want You to Find
It is not surprising that plaintiffs claiming to be injured in auto accidents are often evasive about their prior medical history and treaters. In an article published by the American Medical...
View ArticleClik here to view.
Medicare Secondary Payer and “Future Medicals” A Movement Toward a...
On June 14, 2012, the Centers for Medicare & Medicaid Services (“CMS”) released an Advance Notice of Proposed Rulemaking (“ANPRM”). This document solicits comments on standardized options that CMS...
View ArticleClik here to view.
Affordable Care Act Upheld
This morning the Supreme Court issued its long–awaited decision on the constitutionality of the Patient Protection and Affordable Care Act. The Court upheld the most important feature of the act, the...
View ArticleClik here to view.
Complying With Medicare, Medicaid Reporting Obligations
The Medicare, Medicare and SCHIP Extension Act of 2007 ("MMSEA") requires insurance companies and self-insured employers to report payments and settlements made to claimants who are Medicare-eligible....
View ArticleClik here to view.
SCOTUS Update - Hadden v. United States
The Supreme Court of the United States is meeting today to decide which cert. petitions will be granted for the new term, which formally begins next Monday. One of the petitions distributed for review...
View ArticleClik here to view.
U.S. Supreme Court Decision in Wos v. E.M.A.
On March 20 the U.S. Supreme Court held that the anti-lien provision of the federal Medicaid Act preempts a state’s right to take any portion of a Medicaid beneficiary’s tort judgment or settlement not...
View ArticleClik here to view.
Liability Claims Yield Lower LMSA Figures – Properly Calculating LMSA Amounts
Recently, the U.S. District Court for the Western District of Louisiana issued the Benoit v. Neustrom opinion. 2013 U.S. Dist. LEXIS 55971 (decided April 17, 2013). Here, the parties sought approval...
View ArticleClik here to view.
The Future of Long-Term Care
There is a common shorthand for the general public’s perception about long-term care, frequently referred to as the "70-70-70" problem:•70 percent of the people over age 65 will need some form of...
View ArticleClik here to view.
Mid-Year Update: Medicare Set Asides in Liability Cases
We’re halfway through 2013, and while we await government regulations on the parameters for funding future medical treatment in cases involving Medicare beneficiaries, there have been several key court...
View ArticleClik here to view.
New Three-Year Deadline for Medicare Reimbursement Takes Effect Today
Effective today, Medicare has three years to claim reimbursement for its subscribers medical costs. This statute of limitations is mandated by The Strengthening Medicare and Repaying Taxpayers (or...
View ArticleClik here to view.
Texas Federal District Court Allows Medicare Advantage Organization’s...
In Humana v. Farmers Texas County Mutual Insurance Company, et al, No. 13-CV-611-LY (W.D. Texas, September 24, 2014) the court denied the defendants’ motion to dismiss and allowed Humana, a Medicare...
View Article
