Category Archives: Medicare Jurisdiction

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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Blog, Medicare Jurisdiction, Medicare Secondary Payer News

CMS conducted a Town Hall Teleconference for Mandatory Reporting and Liability (including Self-Insurance), No-Fault Insurance and Worker’s Compensation on July 25, 2013.  Callers used the opportunity to enlist substantive CMS responses regarding overall Medicare Secondary Payer Compliance.  CMS intimated to expect some new updates in the near future, while still addressing a number of recurring themes. SMART Act Update Right …
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Suing Medicare Does Not Work. Again.

01 Aug 2013 Jeffrey Santoro No Comments

Blog, Medicare Jurisdiction, Medicare Secondary Payer News, Uncategorized

The USDC for the Southern District of Ohio has confirmed, yet again, that an action against Medicare cannot be commenced until all administrative remedies have been exhausted.  The underlying action resulted from an MVA where the plaintiff was a Medicare beneficiary.  After settlement of the action Medicare sought recovery of its conditional payments for plaintiff’s medical treatment, which were approximately …
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Blog, Medicare Jurisdiction, Medicare Secondary Payer News

The U.S. filed this lawsuit seeking damages for items and services paid by Medicare related to a settlement.  The underlying litigation involved a significant and well known mass tort case alleging exposure to polychlorinated biphenyls (PCBs).  The matter settled for $300M on September 9, 2003.   On December 9, 2009, the United States filed a lawsuit demanding reimbursement based on the …
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Blog, Medicare Jurisdiction, Medicare Secondary Payer News

The following is an excerpt from a letter sent to the members of MARC (Medicare Advocacy and Recovery Coalition).  Clearly, this is a pivotal time for the implementation of this new law.  These notices represent an important step forward in the process.  We wanted to alert you to a pair of recently published notices in the Department of Health and …
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Blog, Medicare Jurisdiction, Medicare Secondary Payer News, Uncategorized

We have written on this issue before.  Medicare beneficiary files a personal injury claim and but refuses to divulge his or her Social Security Number to protect their privacy.  Making certain seniors are protected from fraud and identity theft,  ( CLICK HERE FOR VIDEO ) the Department of Health & Human Services promotes through various media outlets the importance to not …
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Blog, Medicare Jurisdiction, Medicare Secondary Payer News

A debt to the United States is established under the Medicare Secondary Payer Act, owed by insurance companies (including self insurance), for conditional payments which remain outstanding for more than 60 days after a settlement, judgment or award is secured.  To prevent this debt from ever occurring, proactive insurance companies (including self insurance) have actively pursued securing an appropriate demand …
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Morgan vs. Villa

11 Apr 2013 Roy Franco No Comments

Blog, Medicare Jurisdiction

Facts:   Plaintiff resolved his personal injury action with defendant for the limits of defendant’s policy – $50,000.   The amount would not be sufficient to resolve all of the known liens and plaintiff commenced an action in State Court seeking an Order that would allocate what should be paid each lien holder.   As part of its moving papers, plaintiff made it …
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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, Medicare Advantage Part C, Medicare Conditional Payments, Medicare Jurisdiction, Pharma Part D

Potts vs. Rawlings Company LLC- 2012- U.S. Dist. Court for Southern Dist. NY Facts: This interesting case involves a putative class action against Medicare Advantage (MA) Plans, including Part D Drug Plans.   Plaintiffs sought protection from defendants’ reimbursement claims for conditional payments under New York State General Obligation Law §5-335.  Because this State Law prohibits Defendants, as benefit providers, from …
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