Category Archives: Trial Practice

Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Secondary Payer News, Trial Practice

Franco Signor was invited for oral argument for the MSP False Claims Act case titled Takemoto v. Ace, et. al (Western District of New York) of defendants’ joint motion to dismiss plaintiff’s Amended Complaint before the court held on June 3, 2015. To remind our readers, this False Claims Act case is plaintiff’s (Dr. Kent Takemoto, relator) attempt to recoup …
READ MORE

Legal/Legislative News, Trial Practice

In an opinion out of the United States District Court for the Eastern District of Pennsylvania, Villare v. GEICO Casualty Company, 2015 U.S. Dist. LEXIS 36488, what would have been a finalized settlement came to a screeching halt due to disagreement over what, if any, Medicare Secondary Payer (MSP) obligations were required in settling a liability claim with a 64 …
READ MORE

Blog, Medicare Conditional Payments, Medicare Jurisdiction, Trial Practice

The Medicare Secondary Payer (MSP) Private Cause of Action (PCOA) provides for double damages when a primary plan fails to pay for Medicare’s conditional payment.  See 42 USC §1395y(b)(3)(A).  How to trigger the primary plan’s responsibility under this law has been at the forefront of recent MSP decisions that have come down as of recent. The MSP PCOA is a …
READ MORE

Blog, LMSA, Trial Practice

Legal Practitioners continue to seek guidance from Courts in absence of Centers for Medicare & Medicaid Services (CMS) rules on how to protect Medicare’s interest in a liability settlement.  We field calls every day from frustrated attorneys and claim handlers because of their concern about taking the right action to protect Medicare’s interests post-settlement.  CMS’ withdrawal of the NPRM on …
READ MORE

Blog, Trial Practice, WCMSA

The recent decision in the case of In re Arellano, 2015 Bankr. LEXIS 9 for the U.S. Bankruptcy Court for the Middle District of Pennsylvania made new law with regard to workers’ compensation settlements. One part dealt with whether a lump sum settlement amount could be exempt from the Bankruptcy estate. This issue did not involve the Medicare Secondary Payer …
READ MORE

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

Blog, Medicare Conditional Payments, Trial Practice

Last year we blogged about the District Court’s opinion in McDonald v. Indemnity Insurance, 2013 U.S. LEXIS 138068 (W.D. KY).  At that time, the Court held the Plaintiff could not establish an MSP private cause of action against the defendant, but declined to enter judgment until the Parties provided additional briefing on the MSP statute in light of the Bio-Medical …
READ MORE

Blog, Trial Practice, WCMSA

In Benoit v. MMR Group et. al., 2014 La. App. LEXIS 716, the state court of appeals was asked to rule on an applicant’s attorney request for fees related to seed money secured from an insurer for a WCMSA.  The court examined the approval documents for the WCMSA from CMS review contractor and noted the prohibitory language regarding the award …
READ MORE

Blog, Medicare Conditional Payments, Trial Practice

Personal injury attorney has filed a False Claims Act lawsuit against a number of insurance and self insurance companies doing business in the Western District of New York. J.  Michael Hayes alleges he has personal knowledge of fraud by defendants in concealing disclosure of claims involving Medicare beneficiaries since 2003.( Read Part 1 of the Complaint ) ( Read Part 2 of the Complaint ) …
READ MORE

Allocation, Blog, Medicare Set Aside, Trial Practice

On November 21, 2013, the Oklahoma Civil Court of Appeals decided a case about whether an Employer was forced to disburse a proposed Medicare Set Aside amount, when it was later determined Claimant was ineligible for Medicare benefits.  The ruling was for the Employer and against the Claimant.  In this case, the settlement included a clear record regarding the Medicare …
READ MORE

© 2012-2017 Franco Signor LLC