Category Archives: Reimbursements

Medicare Conditional Payments, Reimbursements

Hearn v. Dollar Rent A Car, Inc., 2012 Ga. App. LEXIS 338 – Public Policy does not require Medicare to be added as a co-payee to a settlement check without the prior approval of the plaintiff. Facts:  This matter was heard by an Appellate Court in Georgia.  It involves a claim for breach of a settlement agreement.  After execution of …
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Auto Club Insurance Association vs. The United States

11 Jun 2012 Roy Franco No Comments

Medicare Conditional Payments, Medicare Jurisdiction, Reimbursements

Auto Club Insurance Association vs. The United States, 103 Fed. Cl. 268, 2012 U.S. Claims LEXIS 28 (U.S. Court of Federal Claims) – The Medicare Secondary Payer Act is not a money mandating statute.  Therefore, a private no-fault insurer is barred against recovery from Medicare claiming to be a secondary payer. Facts:  Plaintiff is a no-fault insurance carrier.  As a …
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Medicare Conditional Payments, Medicare Jurisdiction, Reimbursements

Mason v. Sebelius, 2012 U.S. Dist. LEXIS 40592 (U.S. Dist. Court for the Dist. of New Jersey) Facts:  Plaintiff was injured in a slip and fall accident at the Showboat Hotel and Casino.  Medicare paid for his injuries in the amount of $2,503.  Plaintiff and his wife filed suit seeking damages for Plaintiff’s pain and suffering, medical costs, and for …
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Medicare Conditional Payments, Reimbursements

Salveson vs. Sebilius 2012 U.S. Dist. LEXIS 66293 (U.S. Dist. Court for the Dist. of South Dakota, Southern Div.) Facts:  Plaintiff was injured during surgery.  Her bowel was nicked during hernia repair causing fecal material to leak into her abdominal cavity, eventually causing infection and then sepsis.  She resolved her claim for medical malpractice in the amount of $621,000 on …
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Hadden v. U.S. Petition for Writ of Certiorari Filed

30 Mar 2012 Roy Franco No Comments

Blog, Medicare Conditional Payments, Reimbursements

Congratulations to MARC on filing the Petition for Writ of Certiorari at the Supreme Court today in the matter of Hadden v. U.S. The case is on appeal from the 6th Circuit Court of Appeals See Hadden v. U.S., 2011 U.S. App. LEXIS 23289, (6th Cir. November 21, 2011) on the issue of whether the government is entitled to full …
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How to use the fixed percentage option

16 Feb 2012 Roy Franco No Comments

Blog, Medicare Conditional Payments, Reimbursements

As of November 7, 2011, for liability insurance claims that settle for $5,000 or less, the Medicare beneficiary claimant is able to elect to pay Medicare 25% of his/her settlement rather than proceeding through the traditional recovery process. The “Fixed Percentage Option” as it is called, is an option that both the parties involved with the liability claim should carefully …
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Blog, Medicare Conditional Payments, Reimbursements

Hadden v. U.S., like it or not, is already having an impact on Medicare Secondary Payer litigation in New York.  In less than a week of our blog on this important case, both sides to a protracted battle over the breadth of 42 U.S.C. Section 1395y(b) have cited us to supplement their pending Motion before the U.S. District Court.  Long …
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Blog, Medicare Conditional Payments, Reimbursements

In a split decision, the 6th Circuit Court of Appeals recently held that Medicare’s right to be completely repaid for medical items and services related to a personal injury claim could not be decreased based upon principles of fault.  See Hadden v. U.S., 2011 U.S. App. LEXIS 23289, (6th Cir. November 21, 2011). The 6th Circuit’s decision should be appealed …
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Allocation, Blog, Medicare Conditional Payments, Reimbursements

Most states follow the rule that a plaintiff can recover more than what an insurer pays when it comes to medical bills paid related to the incident. However, a growing number of states are beginning to consider the practical application of rules limiting such awards to those payments actually made by the insurer. In Haygood v. Escabedo, 2011 Tex. LEXIS …
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Blog, Medicare Conditional Payments, Reimbursements

A serious issue currently facing most insurers is learning how to comply with the Medicare Secondary Payer Act without triggering a bad faith claim under a particular state’s Fair Claims Practices Act. The problem arises when the insurer is unaware of the reimbursement claim due to Medicare until after a settlement, judgment, or award. Only an estimate is available to …
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