The Official Medicare Set Aside Blog And Information Resource

CIGA Wins Partial Summary Judgment on Issue of Over-inclusive Reimbursements

Conditional Payments, Jen Article, Medicare Set-Aside Blog, MSP Litigation on January 9, 2017 | Posted by Jennifer Jordan, JD, MSCC

On January 5, 2017, the U.S. District Court for the Central District of California ruled in favor of the California Insurance Guarantee Association (CIGA) in its ongoing challenges against CMS over its MSP practices. After several years and many amended complaints, the only remaining issue in this litigation was CIGA’s allegations that CMS calculates its […] Continue

More MSPA Claims 1 Cases Dismissed

Commentary, Medicare Set-Aside Blog, MSP Litigation on August 10, 2016 | Posted by Jennifer Jordan, JD, MSCC

In its continuing efforts to bring MSP recovery claims against all PIP insurers in Florida under an alleged assignment from a now defunct Medicare Advantage Organization, MSPA Claims 1, LLC has had two more of its federal cases dismissed. What is unique about these two dismissals is that they are based on the various assignments […] Continue

MSPA Claims 1, LLC cases Remanded Back to State Court

Commentary, Medicare Set-Aside Blog, MSP Litigation on July 15, 2016 | Posted by Jennifer Jordan, JD, MSCC

In the ongoing pursuit of PIP reimbursements with double damages under the Medicare Secondary Payer Act, two MSPA Claims 1 cases have been remanded back to state court. Because early cases failed in federal court on the basis of plaintiff being required to actually demonstrate responsibility before filing suit, MSPA Claims 1 moved its efforts […] Continue

A Reminder that there is no MSP Reimbursement Obligation Until CMS Makes a Demand

Commentary, Medicare Set-Aside Blog, MSP Litigation on July 14, 2016 | Posted by Jennifer Jordan, JD, MSCC

While always entertained by pro se plaintiffs who take on the man, an interesting MSP opinion came out of the Eastern District of NY on July 11, 2016. Upon receipt of a conditional payment letter, indicating that Medicare had paid $678.60 for treatment related to his accident and in large, bold letters that it was […] Continue

Humana Stretches Boundaries of MSP Private Cause of Action Again

CMS, Commentary, Medicare Set-Aside Blog, MSP Litigation on May 11, 2016 | Posted by Jennifer Jordan, JD, MSCC

In the Fourth Circuit, Humana is currently pursuing reimbursement from the attorneys representing a passenger in a motor vehicle action under the persons in receipt of settlement funds provision of the MSP in yet another attempt to get the courts to grant Medicare Advantage Organizations (MAOs) the same rights as the federal government with regard […] Continue

The MSP is not so “Extraordinary” that it Completely Preempts State Law

CMS, Commentary, Medicare, Medicare Set-Aside Blog, MSP Litigation on May 4, 2016 | Posted by Jennifer Jordan, JD, MSCC

Great MSP case reported out of Pennsylvania on May 3, 2016 involving what the MSP does not do, in particular, preempt state law under any circumstances. From the brief facts presented in the background,  it is clear that the parties arrived at a lump sum settlement agreement and that the insurer attempted to button up […] Continue

Medicare Recovers Despite Failure to Treat Being the Claim

CMS, Commentary, Liability, Medicare, Medicare Set-Aside Blog, MSP Litigation on March 4, 2016 | Posted by Jennifer Jordan, JD, MSCC

Alleging medical damages and receiving compensation for release from liability for those same medical damages will result in reimbursing Medicare for related medical expenses pretty much regardless of your legal theory as to why you should keep that windfall rather than the federal government. On March 3, 2016, the U.S. District Court for the Eastern […] Continue

NJ District Court Permits False Claims Act Suit Against Progressive to Continue

CMS, Commentary, Medicare, Medicare Set-Aside Blog, MSP Litigation on March 2, 2016 | Posted by Jennifer Jordan, JD, MSCC

On March 1, 2016, the U.S. District Court for the District of New Jersey denied a motion to dismiss in a False Claims Act (FCA) suit against Progressive Insurance, essentially granting standing to the relators. Case involves Progressive “health first” auto policies sold online in New Jersey that caused Medicare to be billed as primary […] Continue

Takemoto False Claims Act Suit Finally Dismissed with Prejudice

Medicare Set-Aside Blog, MSP Litigation on January 22, 2016 | Posted by Jennifer Jordan, JD, MSCC

For anyone following the ongoing saga of Kent Takemoto’s final attempt to cash in on the insurance industry’s obligations to Medicare, we have finally reach the conclusion. On January 20, 2016, the U.S. District Court for the Western District of New York accepted the magistrate judge’s recommendations and dismissed the suit with prejudice, at least […] Continue

Supreme Court Provides Argument Against Post-Settlement Bass Boat Purchases

Commentary, Fraud, Medicare, Medicare Set-Aside Blog, MSP Litigation on January 20, 2016 | Posted by Jennifer Jordan, JD, MSCC

We joke quite regularly about how quickly settlement funds will disappear and what will be bought. Well the Supreme Court today may have just made that less amusing for plaintiffs. In an 8-1 decision, the United States Supreme Court prevented an ERISA plan from recovering from a plaintiff who settled a third-party claim for $500,000 […] Continue