The Official Medicare Set Aside Blog And Information Resource

CMS Issues Updates for Medicare Advantage and Prescription Drug Benefit Program: Will it Affect Your WCMSA?

CMS, Medicare Advantage, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Opioids on April 5, 2018 | Posted by Jean S. Goldstein, JD

Earlier this week, CMS issued a policy change revising the Medicare Advantage Program (MAP) Part C regulations and Prescription Drug Benefit program (Part D).  The ultimate goal of the new policy is to ensure that individual’s treatment needs are met, while improving the quality of care and providing greater choices to MA enrollees.  The full […] Continue

11th Circuit Finds MAOs May Bring Double Damages Private Cause of Action Against Medical Providers

CMS, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on March 21, 2018 | Posted by Jean S. Goldstein, JD

The 11th Circuit issued an opinion yesterday on a Motion to Dismiss on a claim addressing a new question, one they have never been faced with before: Whether an MAO has a private cause of action against the recipient, or a provider of a primary payment. Claims v. Bayfront Hma Med. Ctr., 2018 U.S. Dist. […] Continue

Second Circuit Court Addresses Whether An MAO May Bring Suit: Primary Payer Takes the Hit

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on March 15, 2018 | Posted by Jean S. Goldstein, JD

Nearly every week those of us in the Medicare Secondary Payer (MSP) industry receive alerts about a new Medicare Advantage Organization (MAO) bringing suit for failure to provide reimbursement for conditional payments made by an MAO on behalf of a Medicare beneficiary.  Many of these suits come out of the Third and Eleventh Circuits, and […] Continue

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

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

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

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