Reimbursement
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 […]
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, […]
Medicare Conditional Payment Notices
Yesterday I saw more Conditional Payment Notices from Medicare in one day, than I had the entire month of April. Conditional Payment Notices (“CPNs”) are different than Conditional Payment Letters (“CPLs”), but they should not concern you if you know how to respond. This post will discuss what is a CPN, what do to with […]
ERISA Liens – Plaintiffs’ Attorneys: What You Need to Know
There are three new cases in the ERISA subrogation world (and one pending decision) that you need to be aware of when settling a personal injury lawsuit. As if the ERISA arena isn’t complicated enough, you need careful analysis to determine if these new cases help or hurt your case. New, Favorable Cases for Plaintiffs’ […]
Does Medicare’s New Final Demand Comply with Haro?
On Monday, June 27, 2011, the Medicare Demand Freeze of 2011 ended. It took the MSPRC and its parent organization, the US Department of Health and Human Services (HHS) at least 50 days to rewrite the Medicare Final Demand Letter. For weeks we speculated that Haro v. Sebelius had forced the MSPRC to end its […]
Haro v. Sebelius – Medicare Collections
In early May, Judge David C. Bury of the United States District Court of Arizona wrote the opinion for a major Medicare collections case, Haro v. Sebelius. Like much of the MSP Compliance profession, we have reviewed that case over the past few postings. Today’s posting is a short recap. First, Judge Bury’s holding: “IT […]
Haro v. Sebelius – No Interest During Waiver/Appeals
Last week, the United States District Court for Arizona decided to enjoin Medicare and its agents from charging interest on unpaid MSP claims where the plaintiff has an ongoing Medicare waiver or appeal. The holding in Haro v. Sebelius includes: “IT IS FURTHER ORDERED that the class is certified and defined as follows: ‘persons who […]
Bradley v. Sebelius: Medicare Not Entitled
On September 29, 2010, the 11th Circuit Federal Court ruled that Medicare is not entitled to the proceeds of a wrongful death settlement paid to the surviving children of a Medicare recipient. This news is a welcome addition to the personal injury world, where Tort reform has put caps on many death case recoveries. Could […]
The Idiot’s Guide to Medicare Lien Resolution
Typically, Medicare liens are placed on the personal injury case of a person whose treatment is paid by Medicare. Medicare’s agents, the COBC, MSPRC, and CMS have a right to recover funds which would not have been paid without the negligent act which harmed the plaintiff-beneficiary. If you are the Medicare beneficiary and plaintiff in […]
What if Medicare’s Lien Exceeds Client Recovery
What do you do if a Medicare lien exceeds your client’s recovery? Obviously, if Medicare were to take 100% of proceeds from a settlement or verdict, plaintiffs would have no motivation to file lawsuits. As a result, Medicare liens can be reduced through both automatic, and plaintiff-initiated processes. But remember, Medicare does not truly negotiate […]
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