Category Archives: Medicare Conditional Payments

Blog, Medicare Conditional Payments, Reimbursements

Those of us who regularly handle claims involving Medicare beneficiaries are closely following Hadden v. U.S., 2009 U.S. Dist. LEXIS 69383. Medicare will not adjust its demand based on fault or other defenses to the case, and Medicare will always demand 100% of the services it provides. This is the principle laid out in the lower court of Hadden; but …
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Allocation, Blog, Medicare Conditional Payments

The Medicare Secondary Payer Act (MSP) was passed in response to a dramatic increase in Medicare expenditures. See Baptist Mem’l Hosp. v. Pan Am. Life Ins. Co., 45 F.3d 992, 997 (6th Cir. 1995). “In the MSP statute Congress made Medicare coverage secondary to any coverage provided by private insurance [and self insureds] programs. It did so in order to …
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Allocation, Blog, Medicare Conditional Payments

The Medicare Secondary Payer Act (MSP) was passed in response to a dramatic increase in Medicare expenditures. See Baptist Mem’l Hosp. v. Pan Am. Life Ins. Co., 45 F.3d 992, 997 (6th Cir. 1995). “In the MSP statute Congress made Medicare coverage secondary to any coverage provided by private insurance [and self insureds] programs. It did so in order to …
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Allocation, Blog, Medicare Conditional Payments

It was always assumed Medicare would abide by state rulings.   Consequently, my interest is always peaked when I hear CMS commentary on the topic.  For instance, at the Town Hall Conference Call for Mandatory Insurance Reporting on June 30, 2010 – the issue came up and what I took away from it was a CMS point of view that not …
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Blog, Medicare Conditional Payments, Reimbursements

Got Medicare?  If your Company/Insurance Carrier is ready to settle a case with a Medicare beneficiary is there an easy way to avoid Medicare Secondary Payer Liability?  The short answer is yes, but you will need the Medicare beneficiary to agree, and chances are they will not. The Trust Fund must be reimbursed after a settlement with a Medicare beneficiary. …
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Allocation, Blog, Medicare Conditional Payments, Reimbursements

Our office regularly provides consulting advice on the issue of how to steer the Medicare component of a liability claim, involving a Medicare beneficiary, which is destined for trial.   When working with the defense, we recommend that a pleading be filed with the court and served upon plaintiff’s counsel wherein the medical treatment and Medicare expense are methodically set forth.  …
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Blog, Medicare Conditional Payments, Reimbursements

Is the collateral source rule a defense to reimbursement to Medicare?  No.  At least that is the answer by a New Jersey Appellate Court in its decision that makes settlements, awards and judgments subject to reimbursement to Medicare under the Medicare Secondary Payer Act (MSP), despite state collateral source rule defenses. The decision, which came down on May 24, 2010, …
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