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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Blog, Medicare Conditional Payments, Reimbursements

Those of us who regularly handle claims involving Medicare beneficiaries are closely following Hadden v. U.S., 2009 U.S. Dist. LEXIS 69383. Medicare will not adjust its demand based on fault or other defenses to the case, and Medicare will always demand 100% of the services it provides. This is the principle laid out in the lower court of Hadden; but …
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Blog, Medicare Reporting Section 111, RRE

Seger v. Tank Connection, LLC, Docket No. 8:08CV75 (D.Neb. 2010) is less than a few months old but is already having an impact on at least one State Court ruling regarding disclosure to insurance carriers and defendants of plaintiff’s private information. New reporting requirements created by Pub. L. No. 110-73, codified under 42 USC §1395y(b)(8), have established penalties against insurance …
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CMS Issues New Section 111 NGHP User Guide

27 Jul 2010 Roy Franco No Comments

Blog, Medicare Reporting Section 111, Medicare Secondary Payer News, RRE

Version 3.1 of the new NGHP user guide, dated 07/12/2010 was issued this past week by CMS.  Click here for the updated User Guide. Changes from the previously issued version (3.0) may be found at Section 1, starting at page 6. Here are some of the more important highlights for consideration as well as related commentary. 1. Section 7.1 of the …
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Allocation, Blog, Medicare Conditional Payments

The Medicare Secondary Payer Act (MSP) was passed in response to a dramatic increase in Medicare expenditures. See Baptist Mem’l Hosp. v. Pan Am. Life Ins. Co., 45 F.3d 992, 997 (6th Cir. 1995). “In the MSP statute Congress made Medicare coverage secondary to any coverage provided by private insurance [and self insureds] programs. It did so in order to …
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Allocation, Blog, Medicare Conditional Payments

The Medicare Secondary Payer Act (MSP) was passed in response to a dramatic increase in Medicare expenditures. See Baptist Mem’l Hosp. v. Pan Am. Life Ins. Co., 45 F.3d 992, 997 (6th Cir. 1995). “In the MSP statute Congress made Medicare coverage secondary to any coverage provided by private insurance [and self insureds] programs. It did so in order to …
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