Category Archives: Medicare Secondary Payer News

Magistrate’s Recommendation Rejected in Humana Case

29 Sep 2014 Roy Franco No Comments

Blog, Medicare Conditional Payments, Medicare Jurisdiction, Medicare Secondary Payer News, Pharma Part D, Reimbursements, Trial Practice

This past March we wrote about the Magistrate’s recommendation to the Judge handling the Humana Insurance Co. v. Farmers Texas County Mutual Insurance Co. Cause No. 13-CV-611-LY to dismiss the claim. Our analysis of that recommendation can be found here. In brief, we compared the decision process to a boxing match that would inevitably end up in the appellate courts. …
READ MORE

CMS Launches Group Health Plan Recovery Portal

18 Sep 2014 Jesse Hamby No Comments

Blog, Medicare Secondary Payer News

CMS has announced a new Group Health Plan Recovery Portal.  We believe this portal will serve as a model for a potential CMS launch of a non-group health plan recovery portal.  We expect this because the SMART Act requires CMS to do so.  Please evaluate and review this portal and feel free to share comments with Franco Signor.  We look …
READ MORE

Blog, Medicare Reporting Section 111, Medicare Secondary Payer News

Medicare does not assert MSP liability insurance-based recovery claims against settlements, judgments, awards, or other payments where the date of incident (DOI) occurred before December 5, 1980.   This policy is simple in application for traumatic induced injuries, but has presented challenges for claims involving exposure, ingestion or implantation type issues.  The law defines continuous exposure, ingestion or when an implant …
READ MORE

House and Senate Send Bipartisan Letter to CMS

04 Aug 2014 Katie Fox No Comments

Blog, Medicare Jurisdiction, Medicare Secondary Payer News

On July 30, 2014, the House took actions parallel to the Senate by sending a bipartisan letter about the implementation of SMART to CMS.  We again applaud Congress’ actions for the letters and MARC for continuing its advocacy to increase MSP compliance.  We continue to urge all of our clients and friends to consider joining MARC to continue this important advocacy.  Legislation alone does …
READ MORE

Blog, Medicare Jurisdiction, Medicare Secondary Payer News

Circuit Courts are in conflict over the application of the private cause of action within the Medicare Secondary Payer Act (MSP).  42 U.S.C. § 1395y(b)(3)(A) is the section of the MSP law allowing lawsuits against  primary plans if such plan is responsible to pay for medical items and services related to the claim, but somehow failed in that responsibility, causing …
READ MORE

Senate Asks CMS to Speed Implementation of SMART

15 Jul 2014 Jesse Hamby No Comments

Blog, Medicare Secondary Payer News

The U.S. Senate is concerned enough about the implementation of SMART to send a bipartisan letter to CMS asking for an update.  We applaud the U.S. Senate for the letter and MARC for continuing its advocacy to increase MSP compliance.  We urge all of our clients and friends to consider joining MARC to continue this important advocacy. Legislation alone does …
READ MORE

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.

CMS Issues WCMSA User Guide 2.2 Today

03 Jun 2014 sshamrock No Comments

Blog, Medicare Secondary Payer News, WCMSA

Written by: Steve Shamrock, VP of Operations, Clinical Today, the Centers for Medicare & Medicaid Services (CMS), in an effort to improve the WCMSA process, updated its user guide.  A catalyst for the release, was concern over the increase in development letters and requests for additional medical records.  While Franco Signor did not experience this problem to the degree and severity expressed by …
READ MORE

Blog, Medicare Advantage Part C, Medicare Secondary Payer News

The state appellate court in Arizona considered the issue of preemption regarding Medicare Advantage Plans: Does Part C of the Medicare Act and its associated regulations preempt Arizona’s anti-subrogation doctrine?  The court held in the  affirmative, and ruled that a Medicare Advantage Plan (MAP) may seek reimbursement for medical expenses it paid for one of its enrollees from the settlement …
READ MORE

© 2012-2017 Franco Signor LLC