Category Archives: Reimbursements

Ninth Circuit Disagrees with Bradley v. Sebelius

05 Jan 2011 Roy Franco No Comments

Blog, Medicare Conditional Payments, Reimbursements

Recently, the Nevada Federal District Court in Farmers Insurance Exchange v. Leona Forkey 2010 U.S. Dist. LEXIS 137716 upheld the Ninth Circuit’s position in Zinman v. Shalala, 67 F.3d 841 (9th Cir. 1995) that Medicare’s reimbursement claim for conditional payments takes precedence over the claims of any other party.  Citing the Medicare Secondary Payer Manual as authority for its position, …
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Blog, Medicare Conditional Payments, Reimbursements

By Jeff Signor & Roy Franco Surprised? We are not. To alleviate the contingent liabilities created by the Medicare Secondary Payer Act (MSPA) parties must cooperate. Without cooperation on the Medicare topic, there will be more decisions like Zaleppa v. Seiwell, 2010 PA Super 208 (11/17/2010). The MSPA is designed to protect the Medicare beneficiary. Therefore, primary plans cannot deprive …
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Blog, Medicare Conditional Payments, Reimbursements

The liability industry is getting mixed-signals when it comes to achieving finality to a personal injury claim involving a Medicare beneficiary. The Bradley decision may make practical sense, but it is limited in its application: it does not apply to allocation between damage elements of a settlement fund involving a Medicare beneficiary. That issue will be determined in the case of Hadden v. U.S., recently argued in the 6th Circuit Court of Appeals. A broad extension of Bradley to all Medicare beneficiary cases goes against dozens of cases across the country. However, it may have applicability to any common fund settlement. These would include cases with derivative causes of action like loss of consortium or any mass tort situation. Bradley at least for the 11th Circuit could be used to allocate damages between Medicare and non-Medicare beneficiaries to remove some of the dead lock in settlement distributions.

Franco Signor LLC continues to assist its clients with navigation of the MSP maze. Section 111 reporting goes live on January 1, 2011 retroactive to
October 1, 2010 — All Responsible Reporting Entities (primary plans, defendants, insurers, self-insureds) must now capture the data required to report settlements, judgments or awards exceeding $5,000. As our blog demonstrates, we are carefully following all court decisions and CMS guidance in order to provide timely and informed advice to our growing client base. Allow us to assist you on this important topic!

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Blog, Medicare Conditional Payments, Reimbursements

Those of us who regularly handle claims involving Medicare beneficiaries are closely following Hadden v. U.S., 2009 U.S. Dist. LEXIS 69383. Medicare will not adjust its demand based on fault or other defenses to the case, and Medicare will always demand 100% of the services it provides. This is the principle laid out in the lower court of Hadden; but …
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Blog, Medicare Conditional Payments, Reimbursements

Got Medicare?  If your Company/Insurance Carrier is ready to settle a case with a Medicare beneficiary is there an easy way to avoid Medicare Secondary Payer Liability?  The short answer is yes, but you will need the Medicare beneficiary to agree, and chances are they will not. The Trust Fund must be reimbursed after a settlement with a Medicare beneficiary. …
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Allocation, Blog, Medicare Conditional Payments, Reimbursements

Our office regularly provides consulting advice on the issue of how to steer the Medicare component of a liability claim, involving a Medicare beneficiary, which is destined for trial.   When working with the defense, we recommend that a pleading be filed with the court and served upon plaintiff’s counsel wherein the medical treatment and Medicare expense are methodically set forth.  …
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Blog, Medicare Conditional Payments, Reimbursements

Is the collateral source rule a defense to reimbursement to Medicare?  No.  At least that is the answer by a New Jersey Appellate Court in its decision that makes settlements, awards and judgments subject to reimbursement to Medicare under the Medicare Secondary Payer Act (MSP), despite state collateral source rule defenses. The decision, which came down on May 24, 2010, …
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