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SCOTUS Limits Medicaid Lien Recoveries
On March 20, 2013 the Supreme Court released its decision in Wos v. EMA, a federal case determining the legality of North Carolina’s Medicaid recovery statute. The Court held that the anti-lien provision of the federal Medicaid Act prevents a state from taking any portion of a judgment or settlement not designated as medical care. […]
SMART Act: Final/Conditional Medicare Lien Process
Looking back at yesterday’s SMART Act post it is hard to decipher how to properly obtain what we are calling a “Final Conditional” Amount or Lien. We hope the following workflow (including our assumptions and expectations of the future process) will help: T-120 days to settlement – Send an Expected Settlement Notice to the MSPRC; […]
SMART Act: Is Medicare Lien Resolution Smarter Now?
On January 10, 2013, President Obama signed H.R. 1845. Included on the Medicare IVIG Access Bill is the SMART Act. SMART was designed to reform the conditional payment, final demand, and MMSEA Section 111 reporting processes. Click here to read the full text of H.R. 1845. As you can see below, we aren’t as excited […]
House & Senate Pass Medicare’s SMART Act
Both the House and Senate passed the SMART act prior to the Christmas holiday last week. In the House just 3 “no” votes were cast against 401 “yes” votes. The Senate passed the act without a single “no” vote. There is little doubt that President Obama will sign the bill into law. What is the […]
NJ Court: Federal Law Does NOT Mandate Medicare Set-Asides
The United States District Court of New Jersey recently stated (albeit in an Unpublished Opinion) that Federal Law does not mandate Medicare Set-Asides in a liability context. The question arose in Sipler v. Trans. Am. Trucking Inc. following a general settlement for $225,000. After the verbal settlement the defense attorney attempted to insert language stating: […]
AAJ Working Toward 2nd Circuit Allocation of Medicare Lien
The AAJ sent out an update regarding a case where it is attempting to win a major victory for Medicare beneficiaries. The plaintiffs are using Bradley v. Sebelius to try to convince a probate court to allocate the settlement funds and reduce Medicare’s lien. The AAJ writes, In Bradley, the probate court ordered an apportionment […]
ERISA: Amicus Briefs Filed in US Airways v. McCutchen
During the U.S. Supreme Court’s upcoming term, the court is scheduled to hear U.S. Airways v. McCutchen, 663 F.3d 671 (3d Cir. 2011). We have previously written about the issue of equitable doctrines in ERISA: ERISA! ERISA! ERISA! A Primer; Ninth Circuit Reduces ERISA Lien Rights (CGI v. Rose); ERISA Liens: What You Need to […]
Medicare Advantage Plans Entitled to Medicare Liens
In late June, the 3rd Circuit held that Medicare Advantage Plans (“MAP” or “MAPs”) have the same rights to reimbursement as regular Medicare. The district court in In Re Avandia Marketing, 2011 U.S. Dist. LEXIS 63544, (E.D. Penn. 2012) originally held the plans do not have the same rights to reimbursement as regular Medicare. However, […]
CGI v. Rose – 9th Circuit Reduces ERISA Lien Rights
Last Thursday, Public Justice won a federal appeals court ruling limiting ERISA plan’s ability to collect from personal injury lawsuits. This is Public Justice’s second ERISA lien victory in less than a year. Their tireless work has provided plaintiffs with a ray of light for us to fight the ERISA liens that so greatly limit […]
9th Circuit ERISA: CGI v. Rose
We have been told CGI v. Rose, the 9th Circuit version of U.S. Airways v. McCutchen, was decided on with a pro-plaintiff result. We are trying to obtain a copy of the decision now – and we will analyze it as soon as we have it.
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