Category Archives: Legal/Legislative News

Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Secondary Payer News, Pharma Part D, Reimbursements

The Medicare Advocacy Recovery Coalition (MARC) worked diligently over the past eighteen months to develop and introduce the Secondary Payer Advancement, Rationalization and Clarification Act of 2016 (SPARC). Representatives Tim Murphy (18th District Pennsylvania, Republican) and Ron Kind (3rd District Wisconsin, Democrat) sponsored this bipartisan legislation that was immediately referred to the two committees of jurisdiction over Medicare – House …
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Blog, Legal/Legislative News, Medicare Reporting Section 111, TPOC

As required by section 202 of The SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts. For the past three (3) years, the liability TPOC threshold has been maintained at settlements of $1000 or less. CMS has announced via alert that the TPOC threshold for liability claims will remain …
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Blog, Franco Signor News, Legal/Legislative News, Pharma Part D

On September 24, 2016, legislation was introduced to clarify Part D Drug Plans reimbursement rights under the Medicare Secondary Payer law. The legislation will reinforce for these Plans a clear right of subrogation and improvement in Section 111 MMSEA data for improved coordination. To learn more about the proposed legislation, click here. Congratulations to the Medicare Advocacy Recovery Coalition for …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Trial Practice

Medicare Advantage Plans have set their sights on a new target for the MSP Private Cause of Action: Plaintiff attorneys representing Medicare beneficiaries. We have previously only seen these causes of action against insurance companies, self-insureds and providers. In an opinion out of the U.S. District Court for the Eastern District of Virginia, Humana v. Paris Blank LLP, 2016 U.S. …
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Call to Action: The Opioid Epidemic and WCMSAs

09 May 2016 Administrator No Comments

Administration, Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Set Aside

Franco Signor took an important step last week to inform the White House of a practice by CMS with regard to WCMSAs and the current opioid epidemic.  We have all heard the statistics and agree that action must be taken with regard to overuse and the over prescribing of opioids in the United States.  We applaud the administration’s recent efforts …
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Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Secondary Payer News, Trial Practice

In an opinion out of the U.S. District Court for the Middle District of Pennsylvania, Mikiewicz v. Hamorski and Erie Insurance Exchange, 2016 U.S. Dist. LEXIS 58859 (May 3, 2016), the Defendant Erie Insurance Exchange (“Erie”) removed the Plaintiff Helen Mikiewicz’s (“Plaintiff”) auto accident litigation to Federal Court. Erie had initiated removal to Federal Court due to the fact that …
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Blog, Legal/Legislative News, Medicaid Third Party Liability Recoveries, Medicare Jurisdiction, Medicare Secondary Payer News, Trial Practice

In an unpublished opinion out of Illinois, McKim v. Southern Illinois Hospital Services, the issue litigated was whether certain government benefit program liens (e.g., Medicare and Medicaid) were capped by state lien law. As expected, the court disagreed, finding that Federal preemption entitled governmental plans like Medicare, Medicaid and Part D to not be subject to limitations imposed by state …
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Blog, Legal/Legislative News, Medicare Secondary Payer News, Trial Practice

The False Claims Act’s (FCA) purpose is to deter fraud upon the U.S. government, and whistle-blowers are incentivized to bring such actions due to the potential to recover triple damages against the fraudulent entity. With regard to Medicare Secondary Payer (MSP) FCA litigation, we have really only seen two whistleblowers try to bring MSP FCA actions up until now, United …
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Takemoto False Claims Act Case Closed

21 Jan 2016 Heather Sanderson No Comments

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

Earlier last year we blogged about this MSP False Claims Act case being recommended to be dismissed with prejudice by Magistrate Judge McCarthy. For our prior blog and further background on this case, please click here. Yesterday, United States District Judge William Skretny issued a decision and order denying Takemoto’s request to re-plead his case and objections to Judge McCarthy’s decisions. …
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Blog, Legal/Legislative News, Medicare Conditional Payments, MSPRC, Reimbursements

In a decision out of the Supreme Court of Iowa, an attorney, Paul Silich’s (Silich) law license has been suspended for thirty days for failure to timely handle and reimburse Medicare conditional payments and for violating several ethical attorney professional rules. The background of the case involved Silich’s legal representation of a Medicare beneficiary, Nancy Sanderson (Sanderson), who fell out …
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