The Official Medicare Set Aside Blog And Information Resource

Eleventh Circuit Extends the Scope: Who Else is Entitled to Double Damages Under the MSP?

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on September 15, 2020
Posted by Jean S. Goldstein, JD, CMSP

A recent decision out of the U.S. Circuit Court of Appeals for the Eleventh Circuit has extended the scope of who may bring a private cause of action under the Medicare Secondary Payer Act [1] and may therefore be entitled to double damages.  The case is MSP Recovery Claims, Series LLC v. Ace American Insurance Company, et. […] Continue

Eleventh Circuit Finds Medicare Conditional Repayment Lawsuit Not Time-Barred By 3-Year Claims Filing Provision

Conditional Payments, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on February 27, 2020
Posted by Jean S. Goldstein, JD, CMSP

The Eleventh Circuit recently opined that the 3-years claims filing provision found within the Medicare Secondary Payer Act does not apply to a Medicare Advantage Organization (MAO) when filing suit.  The Eleventh Circuit case was initiated by Plaintiff, MSPA Claims, which is a familiar entity in the Medicare Secondary Payer (MSP) litigation space.  As with […] Continue

First Circuit, Massachusetts Court: Assignee of Medicare Advantage Plan May Bring Private Cause of Action for Double Damages

Conditional Payments, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on July 31, 2019
Posted by Jean S. Goldstein, JD, CMSP

Earlier this month, the United States District Court for the District of Massachusetts issued a ruling on a Motion to Dismiss and Motion to Strike Class Allegations involving an insurance carrier and a Medicare Advantage Organization (MAO).  The United States District Court for the District of Massachusetts sits in the First Circuit, which includes the […] Continue

CMS Issues Final Rule for Medicare Advantage and Part D Pricing

CMS, Medicare Advantage, Medicare Set-Aside Blog, Rx/Pharmacy on May 22, 2019
Posted by Jean S. Goldstein, JD, CMSP

Last week, the Centers for Medicare and Medicaid Services (CMS) issued a final rule, (CMS-4180-F) impacting Medicare Advantage Plans (MAP) and Part D programs.  The rule aims to ensure that patients have greater transparency into the cost of prescription drugs, so that beneficiaries can compare options and also enables MAPs to negotiate better prices for […] Continue

CMS Releases Proposals that Will Likely Increase Medicare Advantage Plan Enrollment

CMS, Medicare Advantage, Medicare Set-Aside Blog, MSP News on January 31, 2019
Posted by Jean S. Goldstein, JD, CMSP

Yesterday, CMS released Part II of a set of proposals that CMS indicates “will take significant steps in continuing the agency’s efforts to maximize competition among Medicare Advantage Plans (MAP) and Part D plans.”  Part I of CMS’ proposal was released on December 20, 2018 and included proposed updates to the Part C risk adjustment […] Continue