Category Archives: Reimbursements

Blog, Medicare Jurisdiction, Reimbursements, Trial Practice

An appellate court in Oregon finds there is a binding settlement where the Medicare issue was not explored until after the case settled.   (See Rhoades v. Beck, 2014 Ore) In Rhoades the parties settled the personal injury case for a total of $20,500 ($15,000 to the injured plaintiff and $5,500 to her spouse).  An exchange of letters between the …
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Blog, Medicare Secondary Payer News, Reimbursements

Medicare & Medicaid spend represents close to 25% of the U.S. Budget.  Congressional gridlock makes it impossible to reduce entitlement benefits or increase taxes to pay for those benefits previously promised by Congress.  The only acceptable course of action is to improve on existing recovery mechanisms.  Very little negative public sentiment exists from both sides of the political aisle when …
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Blog, Medicare Conditional Payments, Medicare Jurisdiction, Medicare Secondary Payer News, Reimbursements, Trial Practice

Doglos v. Liberty Mutual, 2013 U.S. Dist. Facts:  In this case the plaintiff brought a complaint for breach of contract for defendant’s failure to timely pay settlement funds.  Plaintiff alleged that the defendant stalled in paying the settlement funds by taking the position that they needed approval from Medicare before they could pay plaintiff. Plaintiff brought a direct suit against …
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Haro Reversed, in Part, by the 9th Circuit

06 Sep 2013 Jeff Signor No Comments

Blog, Medicare Conditional Payments, Reimbursements

Franco Signor Commentary:  If there was any question about a court’s ability to intercede with the Medicare process then the 9th Circuit has answered.  Medicare has broad, sweeping powers to collect its reimbursement amounts.  Anyone in the chain of payment is obligated to answer for a delinquent repayment to Medicare.  Medicare’s power is especially apparent in how the court allowed the …
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Blog, Medicare Conditional Payments, Reimbursements

Caldera v. The Insurance Company of the State of Pennsylvania, 2013 U.S. App. LEXIS 9706 U.S. Court of Appeals – Fifth Circuit.  Appeal from Southern District of Texas Issue:  Does MSP preempt state law that requires a workers’ compensation claimant to obtain preauthorization from the relevant carrier before incurring certain medical expenses? Holding:  It does not, and lower court’s ruling …
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Blog, Medicare Jurisdiction, Medicare Secondary Payer News, Reimbursements

Edith Weinstein v. Sebelius, 2013 U.S. Dist. LEXIS 41594 (U.S. District Court, Eastern District of Pennsylvania, 2/13/2013). Facts & Procedural History: Plaintiff brought actions for wrongful death and survival against Albert Einstein Hospital and other defendants (“Medical Defendants”) for her husband’s prolonged hospitalizations and death between April 10, 2005 and September 4, 2005.   Her complaint sought all damages “allowed, recognized …
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Blog, Reimbursements

Wimberly v. Katruska, 2012 Pa. Dist. & Cnty Facts: Plaintiff and defendant settled this claim for $9,000 and plaintiff was a Medicare beneficiary.  Defendant took the position that it would not disburse the settlement funds until it received confirmation from Medicare that there was no Medicare reimbursement amount. Issue: Whether defendant may condition payment of a settlement upon plaintiff providing …
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Blog, Medicare Conditional Payments, Medicare Reporting Section 111, ORM, Reimbursements

Baumann v. American Family Mutual Insurance Company- 2012- District Court for District of Colorado Facts: Plaintiff was struck by an underinsured motorist on February 5, 2010 and incurred over $200,000 in medical expenses.  Medicare was billed $101,202.98 of that expense and paid $19,523.40 in benefits.  Plaintiff, an insured under two separate automobile policies, issued by Defendant, sought reimbursement for her …
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Blog, Medicare Conditional Payments, Medicare Reporting Section 111, Medicare Secondary Payer News, Reimbursements

Congratulations to all MARC members!  Yesterday, the Energy & Commerce Health Subcommittee successfully completed “markup” and passage of the SMART Act.  Prior to vote, substitution language was introduced by Congressman Tim Murphy which improved the bill by mandating the use of technology.  The new language replaced notice to Medicare by correspondence that triggered a Conditional Payment Demand Letter with the …
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Release Language Is Important

18 Jul 2012 Roy Franco No Comments

Medicare Conditional Payments, Reimbursements

The Pennsylvania Federal Courts have been active with regard to Medicare Secondary Payer issues.  A recent District Court decision highlights the importance Release language plays to mitigate a party’s potential exposure to the Medicare Secondary Payer Act.  The main takeaway: When going to Court to enforce a settlement, do not expect extrinsic or parole evidence to be admissible on the …
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