The Official Medicare Set Aside Blog And Information Resource

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, MSP Litigation, MSP News on October 15, 2019
Posted by Jean S. Goldstein, JD

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

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

Appropriately Administratively Challenging Conditional Payments Saves Insurer from Double Damages

Conditional Payments, MSP Litigation, MSP News on June 26, 2019
Posted by Jean S. Goldstein, JD

Yesterday, an opinion on a familiar case came out of the Sixth Circuit [1].  The case is Duncan v. Liberty Mut. Ins. Co., Civil Action No. 16-CV-12570, 2019 U.S. Dist. LEXIS 106265 (E.D. Mich. June 25, 2019).  You may recall that we discussed this case previously here on our blog in August, 2018.   Last August, […] Continue

At the Intersection of a Longshore Act Claim and a Medicare Secondary Payer Act Claim: Which Side Wins?

Medicare, MSP Litigation, MSP News on April 17, 2019
Posted by Jean S. Goldstein, JD

An interesting case arose out of the United States Court of Appeals for the Ninth Circuit yesterday.  The case is Grimm v. Vortex Marine Constr., No. 18-15104, 2019 U.S. App. LEXIS 11035 (9th Cir. Apr. 16, 2019), and involves an intersection of the Longshore and Harbor Workers’ Compensation Act (LHWCA), and the Medicare Secondary Payer […] Continue

2019 Kicks Off with Another MSP Case in the 11th Circuit: Reminder to be on Alert

Medicare Secondary Payer Recovery Portal, MSP Litigation, MSP News on January 17, 2019
Posted by Jean S. Goldstein, JD

Last week a Medicare Secondary Payer (MSP) case out of the 11th Circuit Court was issued (MSPA Claims 1, LLC v. Scottsdale Ins. Co., No. 18-21525-CIV-MORE, 2018 U.S. Dist. LEXIS 218675 (S.D. Fla. Dec. 12, 2018).  The facts of the case essentially mirror recent other cases that we have seen: Plaintiff, MSPA Claims 1, LLC […] Continue