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, 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

MAP Action Dismissed; Illinois Does Not Join Jurisdictions Allowing for Double Damages, Private Cause of Action…For Now

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on June 5, 2018
Posted by Jean S. Goldstein, JD, CMSP

Over the last several years, we have blogged about MSP Recovery, LLC, a law firm, that has been championing claims nationwide on behalf of Medicare Advantage Plans (MAP).  In their pursuits, MSP Recovery, has alleged that Non-Group Health Plans (NGHPs) are failing to make payment first, and have allowed secondary payers, particularly Medicare Advantage Organizations […] Continue

H.R.5881 Introduced in An Effort to Add Transparency to MSP Reporting Information

CMS, Medicaid, Medicare, Medicare Advantage, Medicare Set-Aside Blog, MSP News on May 22, 2018
Posted by Jean S. Goldstein, JD, CMSP

Last week, Congressman Gus Bilirakis and Congressman Ron Kind introduced legislation (H.R. 5881) in the House of Representatives to amend title XVIII of the Social Security Act, specifically in an effort to provide for transparency of Medicare Secondary Payer (MSP) reporting information.  Congressman Bilirakis issued a press release yesterday stating that, “[t]his legislation will ensure […] Continue