Category Archives: Medicare Conditional Payments

CMS Releases FAQ Document on CRC

26 Oct 2015 Heather Sanderson No Comments

Blog, Medicare Conditional Payments, Medicare Secondary Payer News

Today, October 26, 2015, CMS released a Frequently Asked Question (FAQ) document on the new Commercial Repayment Center (CRC) (click here). The FAQ provides the same/similar guidance previously provided on CMS webinar held on September 17th. However, of particular mention in the FAQ not previously brought to light is that the CRC will generally not issue correspondence/CPNs when the conditional payment …
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Blog, Medicare Advantage Part C, Medicare Jurisdiction, Trial Practice

Infuse bone graft is FDA approved for certain spinal fusion procedures.  In 2002, Humana agreed to reimburse their insureds for off-label use in reliance on Medtronics’ medical literature that touted the benefits of the infuse product while underreporting its adverse effects.  Humana reversed this policy in February 2009 based on medical literature that questioned the safety and efficacy of Infuse …
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Blog, Medicare Advantage Part C, Medicare Conditional Payments

In an opinion out of the United States District Court for the Eastern District of Tennessee, Cariten Health Plan, Inc. v. Mid-Century Insurance Company, 2015 U.S. Dist. LEXIS 126887 (September 1, 2015 decided; September 24, 2015 published), we have another example where a Medicare Advantage Plan (MAP) has sought to establish its right to an MSP private cause of action …
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More MSP Private Cause of Action “Action”

02 Sep 2015 Heather Sanderson No Comments

Blog, Medicare Advantage Part C, Medicare Jurisdiction, Medicare Secondary Payer News, Medicare Set Aside

A new opinion was just released out of the U.S. District Court for the Southern District of Florida, MSPA Claims 1, LLC v. IDS Property Casualty Insurance Company (August 28, 2015). This case involved MSPA Claims 1, LLC (“MSPA Claims”), as an assignee and on behalf of Florida Healthcare Plus (FHCP), a Medicare Advantage Plan (MAP), pursuing Property Casualty Insurance …
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Blog, Legal/Legislative News, Medicare Conditional Payments, Medicare Jurisdiction

CMS issued an alert on August 5th which states the following: On May 9, 2014, the President signed into law the Digital Accountability and Transparency Act (DATA Act). One outcome of this legislation will be to reduce the timeframe for the referral of delinquent debt to the Department of Treasury (“Treasury”) for both Non Group Health Plan (including self-insurance, liability, …
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MSP Medicare Advantage Plan Recovery Rights Case Law Rampant

03 Aug 2015 Heather Sanderson No Comments

Blog, Medicare Advantage Part C

The Medicare Advantage Plan (MAP) system continues to grow; according to the Kaiser Family Foundation, as much as 31% of the Medicare population in the United States is also enrolled in a Medicare Advantage Plan. Recently, we have seen a great deal of case law where courts have had the difficult to task in deciphering whether MAPs and MAP beneficiaries …
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Blog, Medicare Conditional Payments, Medicare Secondary Payer News

Today, July 1, 2015, CMS issued an alert which states that come October 2015, the Benefits Coordination and Recovery Contractor will be transitioning some of its recovery caseload to a new contractor which will be known as the Commercial Repayment Center (CRC). The CRC will be handling conditional payment recovery where CMS is pursuing recovery directly from a liability insurer …
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Blog, Medicare Advantage Part C

In a recently argued claim before the North Carolina Industrial Commission, Wallace v. National Vision, 2015 WL 3745634 (June 9, 2015), the parties had to resolve a Medicare Advantage (MAO) reimbursement claim in a disputed case. The injured worker was a MAO beneficiary. The MAO incurred expenses for the industrial accident because medical treatment was denied by her employer’s plan.   …
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Blog, Medicare Conditional Payments

We recently posted a blog regarding CMS’ May 5th webinar wherein CMS expressed their intent to recover conditional payments in Ongoing Responsibility for Medical (ORM) cases. This statement during CMS’ webinar was somewhat of a surprise, as CMS’ recovery contractor only issues a final demand for reimbursement for conditional payment where a settlement, judgment, or award is presented.   For no-fault …
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Blog, Legal/Legislative News, Medicare Conditional Payments, ORM

Yesterday, CMS held a webinar on the applicable plans newly created right of appeal that went into effect on April 28, 2015. Because of the Strengthening and Repaying Taxpayers (SMART) Act, CMS was required to develop regulations outlining how an applicable plan (workers’ compensation, liability, automobile insurance, no-fault insurance, including self- insurance law or plans) would exercise this right. As …
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