Category Archives: Medicare Conditional Payments

Blog, Legal/Legislative News, Medicare Conditional Payments, Medicare Secondary Payer News, MSPRC Appeals

In a decision out of the Southern District of Florida, Shapiro v. Secretary of HHS, 2017 U.S. Dist. LEXIS 42278 (March 23, 2017), the District Court affirmed a final decision of the Medicare Appeals Council (“MAC”) rejecting a Medicare beneficiary’s challenge to Medicare’s conditional payment recovery. The Medicare beneficiary Plaintiff, Barbara Shapiro (“Shapiro”), was injured in an automobile accident with …
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Part D MSP Reform Legislation Re-Introduced in Congress

20 Feb 2017 Heather Sanderson No Comments

Blog, Legal/Legislative News, Pharma Part D

On Thursday, February 16, Congressman Tim Murphy (R-PA) and Congressman Ron Kind (D-WI) re-introduced the Secondary Payer Advancement, Rationalization, and Clarification Act (SPARC Act – H.R. 1122) into the US. House of Representatives. For our prior blog and a detailed overview of the SPARC Act, click here. For Congressman Tim Murphy’s press release on the SPARC Act’s re-introduction, click here. …
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Blog, Medicare Conditional Payments

Franco Signor always take the position on behalf of our Clients to aggressively dispute unrelated charges related to Medicare’s claim for conditional payment reimbursement.  Our efforts have resulted in well over 90% reductions in charges because of it.  This case, brought by the California Insurance Guarantee Association (CIGA) explains why it is important to remain proactive in managing your conditional …
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Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Secondary Payer News, Pharma Part D, Reimbursements

The Medicare Advocacy Recovery Coalition (MARC) worked diligently over the past eighteen months to develop and introduce the Secondary Payer Advancement, Rationalization and Clarification Act of 2016 (SPARC). Representatives Tim Murphy (18th District Pennsylvania, Republican) and Ron Kind (3rd District Wisconsin, Democrat) sponsored this bipartisan legislation that was immediately referred to the two committees of jurisdiction over Medicare – House …
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Blog, Franco Signor News, Legal/Legislative News, Pharma Part D

On September 24, 2016, legislation was introduced to clarify Part D Drug Plans reimbursement rights under the Medicare Secondary Payer law. The legislation will reinforce for these Plans a clear right of subrogation and improvement in Section 111 MMSEA data for improved coordination. To learn more about the proposed legislation, click here. Congratulations to the Medicare Advocacy Recovery Coalition for …
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Blog, Medicare Advantage Part C

Last week, the National Association of Medicare Set Aside Professionals (NAMSAP) held their annual conference in San Antonio, Texas.  Personally, I was quite excited about the meeting and decided to attend because Judge Lee Yeakel, Judge, U.S. District Court (TX, Western District) would be speaking.   It is rare to hear from a Judge sitting on the Federal bench about his insights …
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LMSA, Medicare Conditional Payments, Medicare Set Aside

A recent opinion out of the Eastern District of New York, Sexton v. Medicare, 2016 U.S. Dist. LEXIS 89815 (July 11, 2016), found that a Plaintiff cannot refute or defeat Medicare’s ability to recover conditional payments until the primary payer has demonstrated responsibility through a settlement, judgment or award. The brief facts involved Plaintiff Kevin Sexton (“Plaintiff”) being struck by …
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Commercial Repayment Center (CRC) Update

01 Jun 2016 Heather Sanderson No Comments

Blog, Medicare Conditional Payments, Medicare Secondary Payer News

Three months ago, we issued a blog (click here to view) regarding the CRC beginning to issue Conditional Payment Notices (CPNs) and Demands on no-fault and workers’ compensation claims where Ongoing Responsibility for Medical (ORM) had been reported. Recall that back on October 1, 2015, the CRC began to share a portion of the Non Group Health Plan (NGHP) recovery …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Trial Practice

Medicare Advantage Plans have set their sights on a new target for the MSP Private Cause of Action: Plaintiff attorneys representing Medicare beneficiaries. We have previously only seen these causes of action against insurance companies, self-insureds and providers. In an opinion out of the U.S. District Court for the Eastern District of Virginia, Humana v. Paris Blank LLP, 2016 U.S. …
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Blog, Medicare Conditional Payments, Reimbursements

In a decision out of the Court of Appeal of California, Karpinski v. Smitty’s Bar, Inc., 2016 Cal. App. LEXIS 277 (April 12, 2016), the Court affirmed the trial court’s decision to enforce a settlement between the Parties, despite the Defendant, Smitty’s Bar (“Smitty’s”) objections and attempts to delay settlement to ensure reimbursement of liens, particularly Medicare conditional payments. The …
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