On January 14, 2020, CMS hosted a Town Hall presentation to discuss issues involving the recovery of conditional payment claims by the Commercial Repayment Center (CRC). The Town Hall included a discussion of the issues below. A copy of CMS’ presentation from the Town Hall is available at https://www.cms.gov/files/document/commercial-repayment-center-crc-non-group-health-plan-nghp-recovery-town-hall-presentation.pdf. Pre-CPN Worksheet RRE Account Managers have the option to
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
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. O
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
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.
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
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 ensu
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 jo