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

MSP Court Decision Sends Warnings Signals to Primary Payers

Conditional Payments, Medicare Set-Aside Blog, MSP Litigation on July 7, 2020
Posted by Jean S. Goldstein, JD, CMSP

A recent decision out of the United States District Court for the District of New Jersey is sending warning signals and a reminder to implement proactive practices to primary payers. The decision arises from Osterbye v. United States, 2020 U.S. Dist. LEXIS 116591, and came before the court on the Defendant’s Motion to Dismiss Plaintiff’s […] Continue

Court Finds Defendant Made Good Faith Effort to Secure SSN to Comply With Section 111 Reporting Requirements

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP Litigation on May 6, 2020
Posted by Jean S. Goldstein, JD, CMSP

As we recently blogged, the comment period for the Centers for Medicare & Medicaid’s (CMS) Section 111 Civil Money Penalties (CMPs) proposed rule closed. This rule contains the circumstances for when the imposition of CMPs would apply, along with some important guidelines of when CMPs would not be imposed based upon good faith efforts to […] 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

Ninth Circuit: Guaranty Fund Is Not Deemed a Primary Plan as Related to Non-Covered Claims; States No Obligation to Reimburse Medicare Conditional Payments on Subset of Claims

CMS, Conditional Payments, Medicare Set-Aside Blog, MSP Litigation, MSP News on October 15, 2019
Posted by Jean S. Goldstein, JD, CMSP

Last week, the Ninth Circuit United States Court of Appeals issued an important decision involving the Centers for Medicare & Medicaid Services, and the California Insurance Guaranty Fund (CIGA) in Cal. Ins. Guarantee Ass’n v. Azar, Nos. 17-56526, 17-56528, 2019 U.S. App. LEXIS 30339 (9th Cir. Oct. 10, 2019). We last discussed this case in […] Continue