The Official Medicare Set Aside Blog And Information Resource

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

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

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, CMSP

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