Category Archives: Medicare Jurisdiction

Blog, Medicare Jurisdiction

Citizens Insurance Company of America v. The United States- 2011- Federal Claims Court Facts: No Fault Insurance Carrier, Citizens Insurance Company of American (Citizens) filed suit against the U.S. with respect to eight motorists injured before the Medicare Secondary Payer Act became effective on December 5, 1980.  Each of the injured motorists was covered by Medicare since 2005.  Citizens paid …
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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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Blog, Medicare Jurisdiction

We’ve written on the difficulty in obtaining jurisdiction against Medicare multiple times. Recently, a U.S. District Court denied the Government’s motion to dismiss a state lawsuit against it for lack of subject matter jurisdiction and the case was remanded back to state court for further proceedings. Although an apparent victory for establishing jurisdiction against the Government, it remains to be …
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Blog, Medicare Jurisdiction

Filing a lawsuit against Medicare to adjudicate the reimbursement claim owed under the Medicare Secondary Payer Act (MSP) requires navigation of a labyrinth of steps before it will be accepted by a Court. The starting point is a determination by Medicare of what it is owed which usually comes in the form of a Final Demand Letter from its contractor, …
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Blog, Medicare Jurisdiction

A recent decision demonstrates the futility of using the courts to establish what is owed Medicare in an ongoing liability or workers’ compensation claim. In this particular situation, plaintiff filed a state court proceeding to recover for injuries she sustained due to an automobile accident. Her lawyers also filed, as part of that state action, a third party complaint against …
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Blog, Medicare Advantage Part C, Medicare Conditional Payments, Medicare Jurisdiction

Before today, it was unclear what rights, if any, a Medicare Advantage Plan had under the Medicare Secondary Payer Act. Most felt that recovery rights of a Medicare Advantage Plan were the same as traditional Medicare under Parts A & B. That’s because 42 C.F.R. §422.108 granted Medicare Advantage Plans the same rights as the Secretary which was thought to …
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Seeking Jurisdiction against Medicare

28 Sep 2010 Roy Franco No Comments

Blog, Medicare Jurisdiction

Commencing litigation against Medicare is difficult.  As a Federal entity, sovereign immunity usually precludes jurisdiction.  Moreover, Congress further insulated Medicare by passing legislation requiring claimants to first exhaust administrative remedies before allowing a case to proceed to Federal court.  See 28 U.S.C. 1331.  Consequently, it could take years before a case is brought before the court and any precedent established.  …
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