News & Analysis as of

Medicare Secondary Payer Act

Medicare Secondary Payer Act Class Actions

There have been a substantial number of putative class actions filed recently against insurers involving the Medicare Secondary Payer Act (MSPA). These cases are typically filed by assignees of Medicare advantage...more

Second Circuit Affirms Dismissal of FCA Cases

by Jones Day on

The Second Circuit affirmed the dismissal of two False Claims Act ("FCA") cases brought by private relators against insurance and other companies based on the alleged failure to reimburse the Centers for Medicare & Medicaid...more

Medicare Secondary Payer – A Lot Less Boring Now

by Reed Smith on

We’ve previously written several posts (not recently) on Medicare secondary payer (“MSP”) issues – which we characterized as “boring.” The recent MSP decision, Humana Insurance Co. v. Paris Blank LLP, 2016 WL 2745297, 187 F....more

Employee Benefits Developments - December 2016

by Hodgson Russ LLP on

The Employee Benefits practice group is pleased to present the Benefits Developments Newsletter for the month of December, 2016. Certain Captive Arrangements Are No Longer Under the Radar - Notice 2016-66, released...more

Insurer Liable for Mandatory Double Damages for Failure to Reimburse a Medicare Advantage Organization for Medicare Benefits It...

by Low, Ball & Lynch on

Humana Medical Plan, Inc. v Western Heritage Insurance Company ____ F.3d ____ 2016 WL 4169120 (11th Circuit, August 8, 2016) - The federal Medicare and Medicaid Acts have been called “among the most completely...more

Eleventh Circuit Finds Mere Existence Of Insurance Contract Satisfies Condition Precedent To Action For Double Damages Under The...

The Eleventh Circuit Court of Appeals recently held that a private insurance company/PART C Medicare Advantage Organization (MAO) may sue a Personal Injury Protection (PIP) insurance carrier for reimbursement of medical...more

Look, up in the sky! It’s a bird, it’s a plane, it’s… uh oh… a Super Lien!

by Carlton Fields on

Liability insurers have always gnashed teeth over the dreaded “super lien” – aka a lien asserted by Medicare for treatment expenses where the patient is reimbursed through a settlement obtained in personal injury litigation....more

Eleventh Circuit Finds Insurer Liable for Medicare Lien Notwithstanding Insurer's Efforts to Satisfy the Lien in Settlement, also...

In a case with far-reaching implications, the Eleventh Circuit Court of Appeals issued an opinion concluding that the Medicare Secondary Payer Act (MSP) permits a private insurance company/PART C Medicare Advantage...more

11th Circuit Awards Humana Double Damages Under Medicare Secondary Payer Act

Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436. Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights...more

Settling Defendants Beware: Eleventh Circuit Holds Settling Insurer Liable for Failure to Protect Medicare Payments Made by...

Congress created an uproar among personal injury tort defendants and their insurers when it passed the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) less than 10 years ago. The $1,000 per day fine for failure to...more

Medicare Advantage Organizations May Sue For Double Damages Under MSP Act - Humana Medical Plan, Inc. v. Western Heritage Ins....

by Carlton Fields on

On August 8, the Eleventh Circuit Court of Appeals decided an issue of first impression in the circuit under the Medicare Secondary Payer (MSP) Act. In sum, the Eleventh Circuit held that a Medicare Advantage Organization...more

CMS’ Web Portal: Final Rule 21 CFR § 411.39 Promises Quick and Efficient Conditional Payment Resolution for Those Able to Abide by...

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has published its long-awaited final rule entitled “Medicare Program: Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal.” From the outset of...more

Compliance With Medicare Secondary Payer Act At Issue In Auto Insurance Case

A recent decision in the District of New Jersey addressed an auto insurer’s obligations to comply with the Medicare Secondary Payer Act. Auto insurers may wish to review their practices and procedures in light of this...more

Florida Supreme Court on Evidence of Collateral Source Benefits

by Wilson Elser on

Ruling Makes It More Difficult for Defendants to Deal with Claims for Future Medical Expenses at Trial - It is not uncommon for a defendant in a product liability case at trial to be faced with an inflated and...more

CMS Finalizes SMART Act MSP Appeals Provisions

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has published a final rule that implements Medicare Secondary Payer (MSP) appeals provisions under the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act). ...more

CMS Publishes Final Rule Establishing Appeal Process for Applicable Plans in Medicare Secondary Payer Cases

by King & Spalding on

On February 27, 2015, CMS published a final rule, effective April 28, 2015, to establish a formal, multilevel administrative appeals process for applicable plans against which Medicare Secondary Payer (MSP) recovery demands...more

CMS Withdraws Medicare Secondary Payer Proposed Rule

by King & Spalding on

The Office of Management and Budget (OMB) has withdrawn an Advanced Notice of Proposed Rulemaking (ANPRM) in which CMS planned to address how Medicare’s interest should be protected in situations where future medical costs...more

CMS Withdraws Proposed Medicare Secondary Payer Rule

by Cozen O'Connor on

On October 8, 2014, the Centers for Medicare & Medicaid Services (“CMS”) withdrew its Notice of Proposed Rule Making (“NPRM”) from the Office of Management and Budget that was to address how Medicare’s future interests should...more

CMS Seeks Comments on Establishment of CMPs Related to MSP Reporting

by Baker Donelson on

CMS recently solicited comments for the development of methodologies and criteria to be used in evaluating whether or not to impose civil money penalties (CMPs) on arrangements of certain group health plans (GHPs) and...more

CMS Issues Proposal Establishing Appeal Process for Applicable Plans in Medicare Secondary Payer Cases

by King & Spalding on

On December 27, 2013, CMS issued proposed changes to the regulation governing Medicare Secondary Payers (MSP) to establish a formal, multilevel administrative appeals process for applicable plans against which MSP recovery...more

Medicaid Secondary Payer Provision in Bipartisan Budget Act of 2013 Undercuts Supreme Court Decisions on Allocation of Medicaid...

by King & Spalding on

On December 18, 2013, the U.S. Senate passed the Bipartisan Budget Act of 2013 (H.J. Res. 59), which includes a provision that will fundamentally alter the way Medicaid Secondary Payer claims are resolved. Under the new...more

CMS Expands MSP Recovery Portal

by Baker Donelson on

Earlier in 2013 the President signed into law the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the “Smart Act”) requiring CMS to establish a web portal for beneficiaries, their attorneys, and authorized...more

Changes to Medicare Secondary Payer Conditional Payment Rules

by Baker Donelson on

Health care providers routinely treat Medicare beneficiaries who are injured from an accident or an employment injury. If another payment source like a personal injury no fault policy, workers’ compensation insurance policy,...more

The SMART Act: A Bipartisan Attempt to Make the MSP Act Workable

by Cozen O'Connor on

On January 10, 2013, President Obama signed into law H.R. 1845, which includes the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act). The SMART Act amends several portions of the Medicare Secondary Payer...more

24 Results
|
View per page
Page: of 1
Cybersecurity

"My best business intelligence,
in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.