#MSP

Medicare Beneficiary Lacks Standing to Assert Private Cause of Action under the Medicare Secondary P

Melisa Zwilling

Apr 24, 2018

Medicare Beneficiary Lacks Standing to Assert Private Cause of Action under the Medicare Secondary P

Recently, the Sixth Circuit Court of Appeals upheld the district court’s decision that a Medicare beneficiary did not have standing to sue under the private cause of action (PCOA) provision of the Medicare Secondary Payer Act (MSP). In Gucwa v. Lawley, 2018 U.S. App. LEXIS 9428, the plaintiffs filed suit against Accident Fund Insurance Company (Accident Fund) under the MSP, arguing that Accident Fund wrongfully refused to pay medical benefits on behalf of the injured plainti

U.S. District Court Upholds Conditional Payment Claim Demand Amount

Melisa Zwilling

Apr 27, 2017

U.S. District Court Upholds Conditional Payment Claim Demand Amount

Parties often wait to finalize settlement until initial information concerning conditional payment claims is received. While this is certainly a worthwhile and often advisable thing to do, the present case, Shapiro v. Sec’y of HHS, No. 15-22151-Civ-COOKE/TORRES, 2017 U.S. Dist. Ct. LEXIS 42278, is a reminder that relying too heavily on the initial conditional payment information can become problematic. The Plaintiff, Barbara Shapiro, was seriously injured in an accident inv

U.S. District Court Again Follows Eleventh Circuit Decision Finding that the Existence of a Contract

Melisa Zwilling

Mar 31, 2017

U.S. District Court Again Follows Eleventh Circuit Decision Finding that the Existence of a Contract

MSP Recovery, LLC v. Allstate Ins. Co., No. 15-21532, 2017 U.S. Dist. LEXIS 41424 (U.S. Dist. S.D. Fla., March 21, 2017) was recently back before the United States District Court for the Southern District of Florida, again on a motion to dismiss. As you may recall, this case was one of the seven consolidated cases included in the Eleventh Circuit decision finding that a contractual obligation alone could satisfy the “demonstrated responsibility” requirement of the private cau

U.S. District Court Again Relies on Eleventh Circuit Decisions And Allows Medicare Advantage Organiz

Melisa Zwilling

Mar 31, 2017

U.S. District Court Again Relies on Eleventh Circuit Decisions And Allows Medicare Advantage Organiz

In the recent case, Mspa v. Century Sur. Co., No. 16-20752, 2017 U.S. Dist. LEXIS 37040 (U.S. Dist. S.D. Fla., March 15, 2017), the United States District Court for the Southern District of Florida once again considered the rights of Medicare Advantage Organizations (MAOs) to seek reimbursement of medical expenses under the Medicare Secondary Payer Act (MSP). In this case, the enrollee of Florida Healthcare Plus, a Medicare Advantage Organization (MAO), was injured on propert

U.S. District Court Looks To Eleventh Circuit Decision In Deciding Medicare Advantage Organization’s

Melisa Zwilling

Mar 27, 2017

U.S. District Court Looks To Eleventh Circuit Decision In Deciding Medicare Advantage Organization’s

In September 2016, we informed you of an Eleventh Circuit decision in which the Circuit Court found that a contractual obligation alone was enough to establish demonstrated responsibility as required in order to bring a claim under the private cause of action provision of the Medicare Secondary Payer Act (MSP) (see MSP Recovery, LLC v. Allstate Ins. Co., 2016 U.S. App. Lexis 15984). The present case, Claims v. Infinity Auto Ins. Co., No. 15-2504-civ-KING/TORRES, 2017 U.S. Dis

Alert! Eleventh Circuit: Contractual Obligation Sufficient to Establish “Demonstrated Responsibility

Melisa Zwilling

Sep 21, 2016

Alert! Eleventh Circuit: Contractual Obligation Sufficient to Establish “Demonstrated Responsibility

What qualifies as a “demonstrated responsibility” sufficient to proceed under the private cause of action provision of the Medicare Secondary Payer Act has been a recent hot topic of discussion. Following the Eleventh Circuit’s decision in Glover v. Liggett Group, several courts found that a contractual relationship alone would not suffice. Recently, however, the Eleventh Circuit Court of Appeals issued a decision that will change the way that we think about this requirement

ALERT: Eleventh Circuit Holds That Medicare Advantage Organization Entitled to Double Damages Under

Melisa Zwilling

Aug 30, 2016

ALERT: Eleventh Circuit Holds That Medicare Advantage Organization Entitled to Double Damages Under

A number of federal district courts have followed the ruling of the Third Circuit in In re Avandia Sales Practices, and Products Liability Litigation, 685 F.3d (3rd Cir. 2012), finding that Medicare Advantage Organizations (MAOs) have a private cause of action to recover double damages under the Medicare Secondary Payer Act (MSP). In the present case, Humana Med. Plan v. W. Heritage Ins. Co., (2016 U.S. App. LEXIS 14509), the United States Court of Appeals for the Eleventh C

US District Court: Involvement of MSPA Does Not Create a Federal Question

Melisa Zwilling

May 12, 2016

US District Court: Involvement of MSPA Does Not Create a Federal Question

In Mikiewicz v. Hamorski and Erie Insurance Exchange, 2016 U.S. Dist. LEXIS 58859 (May 3, 2016), the United States District Court for the Middle District of Pennsylvania removed the case before them from federal court and remanded it back to state court, finding that the mere involvement of a federal statute is not enough to provide a proper basis for removal from state court to federal court. In remanding the case to state court, the Court applied the well-pleaded complaint

New Process for Obtaining Final Demand PRIOR to Settlement Coming Soon!

Melisa Zwilling

Nov 11, 2015

New Process for Obtaining Final Demand PRIOR to Settlement Coming Soon!

On Monday, November 9th, CMS issued an alert regarding the ability to obtain a Final Conditional Payment Amount prior to settlement finalization which states: "As part of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act), the MSPRP will be modified to include Final CP process functionality by January 1, 2016. This new functionality will permit authorized MSPRP users to notify CMS that a recovery case is 120 days (or less) from an anticipated settle

US District Court: Requires More Than Contractual Obligation to Establish Primary Payer Responsibili

Melisa Zwilling

Oct 12, 2015

US District Court: Requires More Than Contractual Obligation to Establish Primary Payer Responsibili

We continue to see courts acknowledging the rights of Medicare Advantage Organizations (MAOs) to pursue an action for recovery of conditional payments under the private cause of action provision of the Medicare Secondary Payer Act (MSPA). Recently, the discussion has revolved around the requirement to establish an obligation for primary payment before an action under the MSPA is allowed to proceed. Interestingly, courts have found that contractual relationship alone will not

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