Category Archives: Legal/Legislative News

Fix Medicare’s Broken Secondary Payer System

13 Dec 2019 Roy Franco No Comments

Blog, Franco Signor News, Legal/Legislative News

Read Roy Franco’s Op-Ed Published by Inside Sources on December 12, 2019 The deadline has come and gone, and Congress is still working on funding the government for the fiscal year. In late November, lawmakers passed a continuing resolution to give themselves another month to pass required appropriations bills, but important questions remain on how to fund key tax and …
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Blog, Legal/Legislative News, LMSA, Medicare Reporting Section 111, Medicare Set Aside

We have previously blogged regarding two Notice of Proposed Rulemakings (NPRMs) regarding Section 111 Civil Monetary Penalties and MSP and Future Medicals (which will propose options for LMSAs and/or protecting Medicare’s future interest in General Liability claims) pending on the Office of Management and Budget (OMB)’s website. Our prior blog on the Section 111 rulemaking can be found here and …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Secondary Payer News, Pharma Part D

Insurance Companies and Self-Insureds that process claims for workers’ compensation, liability and no-fault claims (Primary Plans) involving Medicare beneficiary claimants need a better way to obtain information about Medicare Advantage and Part D Drug Plans that may have a claim for conditional payment reimbursement.  Numerous lawsuits have been filed across the Country demanding double damages for failure to reimburse Medicare …
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Blog, Legal/Legislative News, Medicare Jurisdiction, Trial Practice

Franco Signor has been following the CIGA (California Insurance Guaranty Association) litigation filed against HHS/CMS for some time. CIGA is California’s largest workers’ compensation provider as the insurer of last resort for employers where the employer/insurer is insolvent and unable to pay claims. Last we blogged about the case in 2017, the litigation was entitled CIGA v. Price, and the …
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Blog, Legal/Legislative News, Medicare Set Aside, WCMSA

We have blogged on numerous occasions regarding Workers’ Compensation Medicare Set-Aside (WCMSA) legislation that continues to be re-introduced in Congress with slight variations over the last decade (hereinafter referred to as “WCMSA Bill”). Our 2018 blog on the prior WCMSA Bill can be found here. The current 2019 proposed WCMSA Bill can be found here. This year, the WCMSA Bill …
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Blog, Legal/Legislative News, Medicare Jurisdiction

CMS recently updated the unified agenda with regard to proposed rulemaking for guidance regarding how beneficiaries were to protect Medicare’s interest in workers’ compensation, liability and no-fault settlements.  The amended announcement now pushes publication of any rule from September 2019 to October 2019.  Another change made was to eliminate all references to line of business and the term “guidance”.  Rather, …
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Blog, Legal/Legislative News, Medicare Advantage Part C

The Wild Wild West of Medicare Advantage Organizations (MAOs) filing litigation nationwide against primary plans (workers’ compensation, liability or no-fault carriers/plans) to establish the right to a Medicare Secondary Payer (MSP) private cause of action for failure to reimburse the MAO for unreimbursed conditional payments continues. As of our last update, both the 3rd Circuit (encompassing New Jersey, Delaware and …
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CMS Updates NGHP User Guide with Minor Changes

08 Jul 2019 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Secondary Payer News

As of July 1, 2019, CMS updated its NGHP User Guide to Version 5.6 with Minor Changes. A list of the changes made in the new Guide can be found here. Additionally, the updated Guide can be found at https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/NGHP-User-Guide/NGHP-User-Guide.html. Contact us with any questions at engage@francosignor.com.

Blog, Legal/Legislative News

Over the last several years, we have been providing updates regarding False Claims Act (FCA) litigation, filed both in Federal and NJ court, against Progressive Insurance Company, wherein a whistleblower, a private citizen, asserted that Progressive was not checking Medicare and Medicaid status of its members prior to enrolling them in their health first automobile insurance policies. By not checking …
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Blog, Legal/Legislative News, Medicare Conditional Payments, Medicare Secondary Payer News, Pharma Part D

Several of our clients have been experiencing an increase in conditional payment letters from Medicare Part D prescription drug plans. Historically, Part D plans have been less active in recovery of conditional payments than traditional Medicare or Medicare Advantage Part C plans; however, the tide appears to be changing. Why are Part D Plans recently increasing their recovery efforts? One …
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