The Official Medicare Set Aside Blog And Information Resource

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

CMS Document SE17019 Reissued; The Effect This Document Has On Your MSA

CMS, Liability, Medicare Set-Aside Blog, MSP News on November 16, 2017 | Posted by Jennifer Alvarez, JD, RN, MSCC, CMSP

As we continue to monitor for guidance from the Centers for Medicare & Medicaid Services (CMS) regarding Medicare Secondary Payer (MSP) compliance and liability/no-fault insurance claims, we have noted a couple of recent changes.  First, on 10/27/17, the CMS Manual System was revised with transmittal 1954 [1], which addressed New Common Working File Medicare Secondary Payer […] Continue

CMS Considering Voluntary Review of Liability MSAs, Again

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on October 26, 2017 | Posted by Jean S. Goldstein, JD

On October 26, CMS once again issued an alert indicating it would be considering expanding the review of voluntary Medicare Set-Asides (MSAs) to include liability insurance and no-fault insurance (LMSAs and NFMSAs).  Just as with other alerts, today’s alert also states that CMS will work closely with the stakeholder community to identify how best to […] 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

New Medicare Secondary Payer Recovery Contract Awarded

CMS, CRC, Medicare Set-Aside Blog, MSP News on October 9, 2017 | Posted by Jean S. Goldstein, JD

On October 5, the Centers for Medicare and Medicaid Services (CMS) awarded Performant Financial Corporation the Commercial Recovery Center (CRC) contract.  The contract was previously awarded to CGI Federal two years ago, when the CRC expanded and assumed responsibility for conditional payment recovery activities directly from Non-Group Health Plans (NGHPs). Performant is not a new […] Continue

Full Medicaid Recovery Coming to a Claim Near You: October 1st

Conditional Payments, Medicaid, Medicare, Medicare Set-Aside Blog, MSP News on September 25, 2017 | Posted by Jean S. Goldstein, JD

As we have seen, Medicare Advantage Plans, Military/Governmental Healthcare Providers, and Private Insurers are aggressively pursuing liens with a priority right approach to recovery.  We often discuss these entities in the context of being a secondary payer, and the omnipresent concern that these entities will seek reimbursement of payments that have been conditionally made, when […] Continue

NEW Workers’ Compensation Review Contractor (WCRC) Contract Awarded

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on September 5, 2017 | Posted by Jean S. Goldstein, JD

Finally, a new Workers’ Compensation Review Contractor (WCRC) award has been issued.  This news comes after several months of work being completed by Provider Resources, the incumbent contractor, under an expired contract.  The new WCRC contract was awarded on September 1, 2017 to Capitol Bridge, LLC of Arlington, Virginia, a certified small business entity.  Capitol […] Continue

Settling a Case in Arizona?  What You Need to Know About Full & Final Settlements

Medicare Set-Asides, MSP News, State Regulations on August 3, 2017 | Posted by Jean S. Goldstein, JD

Historically, workers’ compensation claims in Arizona have been subject to a number of limitations.  If additional medical treatment was needed, a claimant could reopen a claim at any time, despite the finality and resolution of the claim.  As a result, settlement of workers’ compensation claims in Arizona have been far less common because these claims […] Continue