The Official Medicare Set Aside Blog And Information Resource

Evidence of Medicare Advantage Organization Not Acting in Medicare’s Best Interests

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on May 3, 2017 | Posted by Jennifer Jordan, JD, MSCC

For the past year or so, we have watched courts treat Medicare Advantage Organizations (MAOs) as if they were on equal footing as the federal government acting in the best interest of the Medicare Trust Funds.  The courts have manipulated murky laws and regulations to give MAOs reimbursement rights that Congress did not expressly address […] Continue

WC Settlement Used as Evidence that Claimant was not Disabled for Purposes of Social Security Benefits

CMS, Commentary, Medicare Advantage, Medicare Set-Aside Blog, Social Security on June 16, 2016 | Posted by Jennifer Jordan, JD, MSCC

Ever wonder what happens after a case is settled in which no MSA was funded because the parties all agreed that there was no reasonable anticipation of Medicare entitlement within the magical 30 months from the date of settlement?  The answer is as we all suspected:  the claimant proceeds to apply for Social Security Disability […] Continue

Another Case Filed by MSP Recovery for Double Damages Pursuant to Medicare Secondary Payer Act Dismissed for Failure to Demonstrate Payment Obligation

Liability, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on October 5, 2015 | Posted by Joanna Wynes, JD

In MSP Recovery v. Allstate Ins. Co., 2015 U.S. Dist. LEXIS 1380834 (S.D. Fla. Sept. 22, 2015), the United States District Court for the Southern District of Florida dismissed yet another claim filed by, inter alia, John Ruiz, Esquire of La Ley Law firm on behalf of MSP Recovery against another personal injury protection (PIP) […] Continue

Tennessee PIP/MAO Private Cause of Action Scheduled for Trial in September 2016

Liability, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on September 24, 2015 | Posted by Jennifer Jordan, JD, MSCC

Yet another action by a Medicare Advantage Organization seeking recovery from a PIP carrier has been reported out of Tennessee. In this case, Cariten Health Plan is seeking reimbursement of $15,799 paid, out of $55,378.70 billed, on behalf of a Medicare Advantage beneficiary who had PIP coverage through Mid-Century Insurance, a Farmers subsidiary, at the […] Continue

Florida PIP Carriers Beware of a Potential Increase in MSP Reimbursement Demands

Liability, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on September 11, 2015 | Posted by Jennifer Jordan, JD, MSCC

On August 28, 2015, the US District Court or the Southern District of Florida granted yet another motion to dismiss a MSP private cause of action for failing to demonstrate responsibility to make payment sufficient to trigger the Medicare Secondary Payer Act.  While at first I found the opinion rather insignificant given that this is […] 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

Is Medicare Advantage Entitled To Bring A Private Cause Of Action Under The Medicare Secondary Payer Act?

CMS, Medicare, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on June 24, 2015 | Posted by Kimberly Wiswell, CMSP

This law review article by Jennifer Jordan, general counsel at MEDVAL, was recently published in the William Mitchell Law Review. It’s an in-depth analysis of the current state of Medicare Advantage recovery rights and provides a well-reasoned rationale as to whether or not MAOs were intended to share exactly the same recovery rights as traditional […] Continue