The Official Medicare Set Aside Blog And Information Resource

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

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

What Constitutes “Demonstration of Responsibility” in a PIP Claim?

Commentary, Medicare Set-Aside Blog, MSP Litigation on April 14, 2015 | Posted by Jennifer Jordan, JD, MSCC

My understanding of PIP is that it pays regardless of fault.  In fact, Progressive Insurance’s website states:  “PIP Insurance pays for your personal medical expenses or for injuries sustained by your passengers – no matter who is at fault for the accident.”   It is also my understanding that in Florida, PIP subrogation is generally prohibited […] Continue

Courts Can Only Enforce the Law, Making MSAs Tricky at TImes

Commentary, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, MSP Litigation on February 12, 2015 | Posted by Jennifer Jordan, JD, MSCC

The most important thing you can do in any settlement involving a Medicare beneficiary is thoroughly memorialize the measures taken to protect Medicare’s interests. Vague mention in passing can lead to settlements blowing up or one of the parties not receiving what it bargained for. Take for example a recent Second Circuit Court of Appeals […] Continue

Louisiana Court Approves Zero Set Aside in Product Liability Settlement

CMS, Commentary, Medicare Set-Aside Blog, MSP Litigation on January 14, 2015 | Posted by Jennifer Jordan, JD, MSCC

Louisiana courts continue to lead the nation in opining on MSA issues. In a declaratory judgment rendered this week, the court found that plaintiff had presented sufficient evidence from his treating physicians (one of which was a dentist) to demonstrate that he required no further treatment related to a car accident for which he blamed […] Continue