The Official Medicare Set Aside Blog And Information Resource

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

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

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

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