Category Archives: Medicare Jurisdiction

Roy A. Franco Featured in Risk & Insurance

30 Jun 2014 Jesse Hamby No Comments

Franco Signor News, Medicare Conditional Payments, Medicare Jurisdiction, Medicare Secondary Payer News

Roy A. Franco, Franco Signor’s Chief Legal Officer, has written an exclusive article for Risk & Insurance.  This “insider” look at CMS is required reading for anyone involved in Medicare secondary payer claims.  Click here to read the feature.

Blog, Medicare Jurisdiction, Reimbursements

This past February, CMS published a MSP exemption as required by the SMART legislation.  On November 15th of each year, SMART requires the Secretary to publish calculations for this important exemption that applies liability settlements, judgments, awards or other payments involving physical trauma.  Once published the rate would take effect for the following calendar year.  Presently, the threshold amount is set …
READ MORE

Blog, Medicare Jurisdiction, Medicare Set Aside

This is an appeal taken by the injured worker with regard to her pending workers’ compensation claim.  Several issues were raised, but germane to the issue of the Medicare Set-Aside was whether the Employer Insurance carrier could compel medical discovery to assist in the development of a potential Medicare Set Aside.  The State of North Carolina agreed that it could, …
READ MORE

OIG Presents Podcast on 2014 Work Plan

10 Apr 2014 Jesse Hamby No Comments

Blog, Medicare Jurisdiction

The Office of Inspector General is a sister agency to the Centers for Medicare & Medicaid Services within the Health & Human Services Department.  Based on their published work plans for 2013 and 2014, they are more than likely the agency that will be enforcing Section 111 Medicare & Medicaid Schip Extension Act of 2007 (MMSEA) penalties when the rules …
READ MORE

Blog, Medicare Jurisdiction

The Centers for Medicare & Medicaid Services issued an announcement as a result of the U.S. Supreme Court’s decision in United States v. Windsor last year.  When identifying Medicare status it is important to understand this latest development in the law.  Please call us if you have any questions about your Medicare Secondary Payer compliance program.  At Franco Signor we …
READ MORE

Blog, Medicare Jurisdiction, Medicare Secondary Payer News

A revised Alert titled Change in Recovery Threshold for Certain Liability Insurance (including Self-Insurance) Settlements, Judgments Awards, or Other Payments, has been posted to the Downloads section of the Non-Group Health Plan Recovery page. The methodology used to determine this new threshold, titled Computation of Annual Liability Insurance (including Self-Insurance) Settlement Recovery Threshold, can be found here.  

U.S. Remains Aggressive on Fraud, Waste & Abuse

27 Feb 2014 Roy Franco No Comments

Blog, Medicare Jurisdiction, Medicare Secondary Payer News

Yesterday, the Health & Human Services Department (HH&S) issued a press release announcing a record-breaking $4.3 billion dollars in recoveries for calendar year 2013 related to Fraud, Waste & Abuse of its Medicare program.  This announcement is even more impressive as the Department can demonstrate the success of its recovery efforts based on its cost.  In an age of expected government overruns …
READ MORE

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 …
READ MORE

Blog, Medicare Jurisdiction, Medicare Secondary Payer News

The Centers for Medicare and Medicaid Services (CMS) is completing its restructuring of the Coordination of Benefits (COB) and Medicare Secondary Payer (MSP) recovery activities. COB activities for both Group Health Plans and Non-Group Health Plans (that is, liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws or plans) and Recovery activities for Non-Group Health Plans will be transitioned …
READ MORE

Blog, Medicare Jurisdiction, Medicare Secondary Payer News

Published today in the Federal Register is the Proposed Rule for Non-Group Health Plan Appeal Rights required by the SMART Act that was signed into law by President Obama on January 10, 2013.  As a result of the publication, the public has the right to comment on the rule before it takes effect.  This comment period runs through 2/25/2013 and …
READ MORE

© 2012-2017 Franco Signor LLC