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, 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

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

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, CMSP

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

Another MSP Case; Another Court’s Interpretation: Court finds Personal Representative Has Standing to Bring Private Cause of Action  

Medicare Set-Aside Blog, MSP Litigation, MSP News on June 12, 2018
Posted by Jean S. Goldstein, JD, CMSP

Last week, the Fourth Circuit was added to the list of recent jurisdictions addressing the private cause of action provision under the Medicare Secondary Payer act.  The Fourth Circuit has jurisdiction over the District Courts in the states of Maryland, North Carolina, South Carolina, Virginia and West Virginia. In Netro v. Greater Balt. Med. Ctr. […] Continue