If you are attending the New York Self Insurers Association Conference at the Roosevelt Hotel in New York this week, be sure to stop by our booth and visit!  Attorney Melisa Zwilling will be there and is happy to answer your questions about the Medicare Secondary Payer Act.

The most recent Regulatory Agenda for the Department of Health and Human Services includes another notice of a proposed rule on Civil Monetary Penalties and Medicare Secondary Payer reporting requirements.   The text of the notice is set out below and is available at https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201910&RIN=0938-AT86.

Section 516 of the Medicare Access and CHIP Reauthorization Act of 2015 amended the Social Security Act (the Act) by repealing certain duplicative Med...

In its most recent Regulatory Agenda, the Department of Health and Human Services again included a notice of a proposed rule on addressing future medical expenses in workers’ compensation, liability, and no-fault cases.  Previously, CMS anticipated issuing proposed regulations in September 2019.  Earlier this year, the time frame was pushed back to October 2019.  The current Regulatory Agenda now indicates that CMS anticipates issuing proposed regulations in February 2020.  Of course, this is su...

According to current data from CMS, over 36 percent of Medicare beneficiaries are enrolled in Medicare Advantage Plans and over 41 percent of Medicare beneficiaries are enrolled in Medicare Prescription Drug Plans.  As such, there is a high probability when settling a case with a Medicare beneficiary that the claimant is enrolled in either a Medicare Advantage Plan or a Medicare Prescription Drug Plan.  It is important to remember that conditional payment letters from CMS do not include informat...

In Humana, Inc. v. St. Jude Med., LLC, 2019 U.S. Dist. LEXIS 223313, the United States District Court for the Southern District of Florida addressed whether Plaintiff, Humana, through its Medicare Advantage operating subsidiaries, had standing to pursue a claim under the Medicare Secondary Payer Act against Defendant, St. Jude Medical.  Defendant, a manufacturer of cardiac-defibrillator devices, issued a nationwide recall of defective cardiac devices due to battery defects.  The recall required...

In MSP Recovery Claims v. Farmers Ins. Exch., 2019 U.S. Dist. LEXIS 106417 (C.D. Cal. June 12, 2019), the U.S. District Court for the Central District of California addressed the application of the three year statute of limitations to Medicare Advantage Plans and Medicare Advantage Plan assignees.  The case involved prior lawsuits by MSPA Claims 1, LLC and MSP Recovery Claims Series, LLC (Plaintiffs) as purported assignees of Medicare Advantage Plans against several companies in the Farmers Insu...

The United States Attorney’s Office for the Eastern District of Pennsylvania recently announced that Simon and Simon, P.C., a Philadelphia-based plaintiff’s firm, has paid $6,604.59 to resolve allegations that the firm failed to ensure that conditional payment claims were repaid on behalf of eight of the firm’s clients between 2014 and 2019.  In addition to the lump sum payment, Simon and Simon agreed to appoint and train an individual in their firm to be responsible for ensuring the timely repa...

CMS recently announced that they are hosting a webinar to discuss issues with CRC’s recovery of conditional payment claims in cases involving ORM.  The webinar is scheduled for Tuesday, January 14, 2020, at 1:00 Eastern Time.  CMS plans to allow questions and provide answers following the presentation.

In order to view and listen to the presentation, participants will need to use the webinar URL and conference call information below.  CMS requests that participants plan to join at least 15 m...

In the latest installment of the ongoing case MAO-MSO Recovery II, LLC v. State Farm, (2019 U.S. Dist. LEXIS 204397 (C.D. Ill. Nov. 25, 2019)), the District Court of Illinois resolved the matter on the Defendant’s Motion to Dismiss.  The Plaintiffs have attempted to file suit under the Medicare Secondary Payer Act for reimbursement of conditional payment claims paid by Medicare Advantage Plans on behalf of State Farm insureds.  Plaintiffs allege that they are the assignees of the recovery rights...

In Yatsko v. Roehl, (2019 U.S. Dist. LEXIS 194600 (D. Md. November 7, 2019)), the plaintiff, a Medicare beneficiary, was injured in a car accident.  He obtained a settlement, following which Medicare sought reimbursement of conditional payments made on his behalf.  In response to Medicare’s demand for reimbursement, Yatsko filed suit in the District Court of Maryland.  Because Yatsko failed to exhaust his administrative remedies through Medicare in disputing the conditional payment claims, the c...