The Official Medicare Set Aside Blog And Information Resource

Take 2: MAO Class Action Fails on Second Amended Complaint

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on January 4, 2018 | Posted by Jean S. Goldstein, JD

As you may recall, several weeks ago we reported on a new spin in the Medicare Advantage Organizations (MAO) class action realm.  At the root of this latest private cause of action, is a multi-district ligation (MDL) suit involving a blood-thinning drug called Pradaxa.  The MDL settled in May, 2014, and by way of the […] Continue

Another Court Case, Perpetuating the Confusion Surrounding LMSAs

CMS, Liability, Medicare Set-Aside Blog, MSP Litigation on November 29, 2017 | Posted by Jean S. Goldstein, JD

Yesterday, a decision came out of the District Court for New Mexico, based upon an action to determine whether a Medicare Set-Aside was needed in a matter involving a personal injury suit.  (Silva v. Burwell, No. 16-cv-488 JCH/KK, 2017 U.S. Dist. LEXIS 195032, (D.N.M. Nov. 28, 2017).)  The applicability of the Medicare Secondary Payer act […] Continue

More MSPA Claims 1 Cases Dismissed for Standing

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on November 27, 2017 | Posted by Jennifer Jordan, JD, MSCC

The U.S. District Court for the Central District of California dismissed the attempted class action against Mercury General on November 2, 2017. As with the other attempted national actions, standing was the fatal flaw in the pleadings as the plaintiffs fail to state who the alleged participating MAOs are. In order to demonstrate standing “[i]n […] Continue

Another New Spin in the MAO Class Actions

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on October 26, 2017 | Posted by Jennifer Jordan, JD, MSCC

MAO-MSO Recovery II, LLC, et al., v. Boehringer Ingelheim Pharmaceuticals, Inc., et al. was dismissed for lack of standing on October 10, 2017. In this latest MSP private cause of action stemming from the Florida Health Care Plus assignment, this claim sought recovery from the Predaxa MDL settlement that occurred in May 2014. Predaxa is […] Continue

Another Michigan Spine Case

Medicare Set-Aside Blog, MSP Litigation, MSP News on October 16, 2017 | Posted by Jennifer Jordan, JD, MSCC

Opinion out of the U.S. District Court for the Eastern District of Michigan reported on October 13, 2017 shows that the Michigan Spine and Brain Institute is at it again. You may recall that in 2013, there were a series of opinions stemming from a situation in which Michigan Spine was denied payment, billed Medicare […] Continue

Class Action MAO Recoveries Are Continuing

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on October 13, 2017 | Posted by Jean S. Goldstein, JD

On August 10, 2017, MSP Recovery Claims, LLC filed a class action complaint against Safeco Insurance Company of America in a Florida Circuit Court.  Yesterday, the Defendants filed a request for removal of the matter to Federal Court.  (MSP Recovery Claims, Series LLC v. Safeco Insurance Company of America, Case 1: 17-cv23738-UU). As we have […] Continue

CIGA Entitled to Judicial Declaration of Unlawful CMS Interpretation of the MSP

CMS, Medicare Set-Aside Blog, MSP Litigation on May 4, 2017 | Posted by Jennifer Jordan, JD, MSCC

On May 3, 2017, the U.S. District Court for the Central District of California issued its order with regard to CIGA’s entitlement to relief following the court’s award of partial summary judgment in January.  Based upon briefing submitted following that ruling, the Court concluded that CIGA is entitled to:  an order vacating and setting aside […] Continue

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

MAO Recovery & Courts: Aggressively Pursuing Liens

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP Litigation, MSP News on March 17, 2017 | Posted by Jean S. Goldstein, JD

On Wednesday, in the second decision of its kind this month, the United States District Court, Southern District of Florida denied in part and granted in part a Motion to Dismiss in a Medicare Advantage Organization (MAO) Medicare Secondary Payer Act (MSPA) recovery claim. MSPA Claims 1, LLC, et al. v. Century Surety Company, No. […] Continue

MSP False Claims Action Reaching Its Conclusion

Medicare Set-Aside Blog, MSP Litigation, MSP News on January 18, 2017 | Posted by Jennifer Jordan, JD, MSCC

On January 18, 2017, the Second Circuit Court of Appeals brought an end to Kent Takemoto’s dreams of whistle blower riches. The Court upheld the District Court’s adoption of the Magistrate’s recommendation to dismiss the false claims action, finding that he failed to plead facts as to each defendant’s obligation to repay the government. Although […] Continue