The Official Medicare Set Aside Blog And Information Resource

Medicare Recovers Despite Failure to Treat Being the Claim

CMS, Commentary, Liability, Medicare, Medicare Set-Aside Blog, MSP Litigation on March 4, 2016 | Posted by Jennifer Jordan, JD, MSCC

Alleging medical damages and receiving compensation for release from liability for those same medical damages will result in reimbursing Medicare for related medical expenses pretty much regardless of your legal theory as to why you should keep that windfall rather than the federal government. On March 3, 2016, the U.S. District Court for the Eastern […] Continue

NJ District Court Permits False Claims Act Suit Against Progressive to Continue

CMS, Commentary, Medicare, Medicare Set-Aside Blog, MSP Litigation on March 2, 2016 | Posted by Jennifer Jordan, JD, MSCC

On March 1, 2016, the U.S. District Court for the District of New Jersey denied a motion to dismiss in a False Claims Act (FCA) suit against Progressive Insurance, essentially granting standing to the relators. Case involves Progressive “health first” auto policies sold online in New Jersey that caused Medicare to be billed as primary […] Continue

New WCRC RFP Announced

CMS, Commentary, Medicare Set-Aside Blog, MSP News on February 25, 2016 | Posted by Jennifer Jordan, JD, MSCC

On February 22, 2016, CMS announced that it anticipates releasing the WCRC solicitation [Solicitation No: RFP-CMS-2016-8A-0008] on or about March 8th with a bid deadline on April 8th and anticipated award on June 20th. Once again it is an 8(a) contract, meaning that bidding is limited to minority small businesses. The contract will be issued […] Continue

CMS May Finally Be Forced to Address Medicare Appeal Backlog

CMS, Commentary, Medicare, Medicare Set-Aside Blog, MSP News on February 10, 2016 | Posted by Jennifer Jordan, JD, MSCC

On Tuesday, February 9, 2016, the U.S. Court of Appeals for the District of Columbia overturned the December 2014 dismissal of a suit by the American Hospital Association against DHHS for unreasonable delays in processing RAC appeals. At the time the lower court ruled that the delay wasn’t unreasonable enough to elicit an order from […] Continue

Supreme Court Provides Argument Against Post-Settlement Bass Boat Purchases

Commentary, Fraud, Medicare, Medicare Set-Aside Blog, MSP Litigation on January 20, 2016 | Posted by Jennifer Jordan, JD, MSCC

We joke quite regularly about how quickly settlement funds will disappear and what will be bought. Well the Supreme Court today may have just made that less amusing for plaintiffs. In an 8-1 decision, the United States Supreme Court prevented an ERISA plan from recovering from a plaintiff who settled a third-party claim for $500,000 […] Continue

Will the Supreme Court Help Us Figure Out What Will Happen When MSA Funds are Improperly Spent?

Commentary, Medicare Set-Asides, News and Events on November 9, 2015 | Posted by Jennifer Jordan, JD, MSCC

Theoretically CMS is supposed to deny related Medicare payments until such a time that it can be proven that an MSA was properly exhausted on related medical treatment. It is then that the question arises as to what will happen if the Claimant used the money and can’t pay for this own medical expenses. Our […] Continue

More on the Delaware Collateral Source Rule

Commentary, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on August 20, 2015 | Posted by Jennifer Jordan, JD, MSCC

On August 14, 2015, the Superior Court of Delaware used the Stayton decision to rule that future medical damages for Medicare beneficiaries should also be limited by the “amount of projected Medicare write-off.” In this suit following a slip and fall in a retail store, Plaintiff had sought damages for future medical expenses to which […] Continue

Collateral Source Rule in Delaware – Part II

Commentary, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on August 3, 2015 | Posted by Jennifer Jordan, JD, MSCC

In follow up to the Delaware Supreme Court ruling in Stayton v. Delaware Health Corp. [see blog dated June 22, 2015], declaring Medicare payments not subject to the collateral source rule, the Superior Court on July 28, 2015 extended the application to Medicare Advantage Plans as well. In Honey v. Bayhealth Medical Center, plaintiff attempted […] Continue

Medicare Reimbursement and Collateral Source Rule in Delaware

Commentary, Medicare Set-Aside Blog, MSP Litigation on June 22, 2015 | Posted by Jennifer Jordan, JD, MSCC

On June 12, 2015, the Supreme Court of Delaware rendered a decision in Stayton v. Delaware Health Corporation, et al. opining that the collateral source rule would not apply in the recovery sought by the plaintiff. The case involves a 76 year old wheelchair bound resident of the Harbor Healthcare and Rehabilitation Center. Plaintiff is […] Continue

MSP vs PIP – Part 2

Commentary, Medicare Set-Aside Blog, MSP Litigation on May 21, 2015 | Posted by Jennifer Jordan, JD, MSCC

In April we saw our first MSP case involving a PIP carrier denying reimbursement responsibilities for medical benefits related to a covered auto accident that were paid by Medicare. [MSP RECOVERY, LLC v. PROGRESSIVE SELECT INSURANCE CO., 2015 U.S. Dist. LEXIS 47784 (Apr. 1, 2015)]. In that case, court found that plaintiff did “not allege […] Continue