The Official Medicare Set Aside Blog And Information Resource

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

Conditional Payments, Medicare Advantage, MSP Litigation on July 31, 2019
Posted by Jean S. Goldstein, JD

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, Rx/Pharmacy on May 22, 2019
Posted by Jean S. Goldstein, JD

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, MSP News on January 31, 2019
Posted by Jean S. Goldstein, JD

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

As MAPs Continue Recovery Efforts, Florida Court Says the MSP Does Not Preempt State Law

Medicare Advantage, MSP Litigation, MSP News on October 16, 2018
Posted by Jean S. Goldstein, JD

You may recall that we recently blogged about whether the Medicare Secondary Payer (MSP) Act, a Federal law, preempts State law.  A Maryland case quite succinctly addressed this question several months ago finding that State law is not preempted by the MSP if certain conditions are met.  This question was also addressed recently in a […] Continue

Conditional Payments: When Does the Time Clock Run Out?

Conditional Payments, Medicare Advantage, MSP Litigation on October 1, 2018
Posted by Jean S. Goldstein, JD

Last week, in MSPA Claims 1 v. Kingsway Amigo Ins. Co.,  the 11th Circuit addressed the appropriate application of the statute of limitations under the Medicare Secondary Payer Act (MSPA).  At issue in the matter, was whether the Plaintiff, an assignee of a Medicare Advantage Organization (MAO), timely pursued a claim against the Defendant, a primary […] Continue