The Official Medicare Set Aside Blog And Information Resource

A Reminder that there is no MSP Reimbursement Obligation Until CMS Makes a Demand

Commentary, Medicare Set-Aside Blog, MSP Litigation on July 14, 2016 | Posted by Jennifer Jordan, JD, MSCC

While always entertained by pro se plaintiffs who take on the man, an interesting MSP opinion came out of the Eastern District of NY on July 11, 2016. Upon receipt of a conditional payment letter, indicating that Medicare had paid $678.60 for treatment related to his accident and in large, bold letters that it was […] Continue

Humana Stretches Boundaries of MSP Private Cause of Action Again

CMS, Commentary, Medicare Set-Aside Blog, MSP Litigation on May 11, 2016 | Posted by Jennifer Jordan, JD, MSCC

In the Fourth Circuit, Humana is currently pursuing reimbursement from the attorneys representing a passenger in a motor vehicle action under the persons in receipt of settlement funds provision of the MSP in yet another attempt to get the courts to grant Medicare Advantage Organizations (MAOs) the same rights as the federal government with regard […] Continue

The MSP is not so “Extraordinary” that it Completely Preempts State Law

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

Great MSP case reported out of Pennsylvania on May 3, 2016 involving what the MSP does not do, in particular, preempt state law under any circumstances. From the brief facts presented in the background,  it is clear that the parties arrived at a lump sum settlement agreement and that the insurer attempted to button up […] Continue

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

Takemoto False Claims Act Suit Finally Dismissed with Prejudice

Medicare Set-Aside Blog, MSP Litigation on January 22, 2016 | Posted by Jennifer Jordan, JD, MSCC

For anyone following the ongoing saga of Kent Takemoto’s final attempt to cash in on the insurance industry’s obligations to Medicare, we have finally reach the conclusion. On January 20, 2016, the U.S. District Court for the Western District of New York accepted the magistrate judge’s recommendations and dismissed the suit with prejudice, at least […] 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

Personal Injury Attorney Suspended for Poor Handling of Medicare Conditional Payment Reimbursement

Conditional Payments, Medicare, Medicare Set-Aside Blog, MSP Litigation on December 7, 2015 | Posted by Jennifer Jordan, JD, MSCC

Anyone can resolve a Medicare reimbursement. You don’t need to be a lawyer or MSP specialist. But the reason companies like ours exist is because CMS doesn’t make it easy. If you do not know how to navigate the process, it could take a long time. You may contact the wrong contractor and not receive […] Continue

Mary Reale’s Six Year Medicare Part C Saga Continues

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

In the ongoing saga as to whether Medicare Advantage actually has the same recovery rights as the federal government when it comes to Medicare conditional payments, the Court of Appeals of Florida has determined that the underlying state court in Humana v. Reale lacked subject matter jurisdiction in determining an MAO’s reimbursement rights. This decision […] 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