Category Archives: Medicare Conditional Payments

About Franco Signor, Blog, Medicare Advantage Part C

On April 2, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare Advantage Plan (MAP) and Medicare Part D policy changes which provides the plans “with new tools to improve quality of care and provide more plan choices for MA and Part D enrollees.” CMS estimates that the changes will result in $295 …
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Blog, Medicare Advantage Part C, Pharma Part D, Trial Practice

A new decision was handed down from the U.S. Court of Appeals for the 11th Circuit in the Barbara J. Harvey v. Florida Health Sciences Center, Inc. this month.  Here, the Plaintiff pursued a medical malpractice claim against a hospital for her husband’s death.  The hospital agreed to binding arbitration on the sole issue of damages to avoid a lawsuit. …
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Blog, Medicare Advantage Part C, Pharma Part D

The Medicare Advocacy Recovery Coalition (MARC) is an organization made up of insurance companies, third party administrators, defense firms, plaintiff firms and MSP compliance companies. MARC recently announced an important new legislative initiative. Primary Plans which are plagued unfairly by MSP private cause of action claims would have an important tool at their disposal, once the legislation is introduced and …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Trial Practice

The U.S. District Court for the Southern District of Texas has issued an opinion in ongoing litigation by Aetna and Humana, both Medicare Advantage Plans (MAPs), against a Plaintiff law firm that represented asbestos trusts. The allegation by Aetna and Humana (“Plaintiffs”) is that Defendant Shrader Associates LLP (“Schrader”) represented at least fifteen “Matched claimants” that received coverage from the …
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Blog, Legal/Legislative News, Medicare Advantage Part C

Primary Plans Beware: The tide continues to turn across the country in favor of Medicare Advantage Plans (MAPs) having a right to sue primary plans based on the Medicare Secondary Payer (MSP) private cause of action and the ability to seek double damages for the failure to reimburse MAP conditional payments. The decision has the potential to extend the law …
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Blog, Medicare Conditional Payments

Just a reminder that the new Commercial Repayment Center (CRC) contractor goes live today. Click here to read our recent blog on the topic. Click here to download a CRC – NGHP Correspondence Cover Sheet.

Blog, Medicare Advantage Part C

Recall that in September 2016, the Eleventh Circuit Court of Appeals ruled that Humana Medicare Advantage may sue a primary plan for failure to reimburse conditional payments under the Medicare Secondary Payer (MSP) private cause of action for double damages. The Eleventh Circuit encompasses the jurisdictions of Florida, Alabama, and Georgia. For our original blog on the Eleventh Circuit Western …
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Blog, Legal/Legislative News, Medicare Advantage Part C

Previously, we blogged on the “System” created by MSP Recovery LLC to identify potential primary payers in Medicare Advantage Plan (MAO) conditional payment recovery claims.  The Plaintiff, MSP Recovery LLC, testified that they created this unique “System” using the following databases; ISO reports, state car crash databases, MAO claim data, and others.  MSP Recovery has now secured a preliminary $5M settlement in court …
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Blog, Medicare Conditional Payments

Yesterday, January 18th, the Centers for Medicare & Medicaid Services (CMS) conducted a webinar for Non-Group Health Plans (NGHPs) to discuss the transition of the new Commercial Repayment Center (CRC) contractor from CGI Federal to Performant Financial Corp.  On January 17th, a similar webinar was conducted for Group Health Plans (GHPs) with respect to the transition. Ted Doyle, the Project …
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Blog, Medicare Advantage Part C, Trial Practice

We have blogged  about Medicare Advantage Plans (MAPs) and MSP Recovery LLC for quite some time now, but a recent industry blog (“Illinois Court Indicates MAPs Have “Double Damages” Rights”) requires us to also clarify the ruling of this new court decision to avoid  confusion for our Illinois clients about Illinois MAP recovery rights in that state.  To clarify that …
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