Settlement

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. […]

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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; […]

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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 […]

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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 […]

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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The United States District Court of New Jersey recently stated (albeit in an Unpublished Opinion) that Federal Law does not mandate Medicare Set-Asides in a liability context.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: […]

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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 […]

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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, […]

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LRS Public Comment: CMS-6047-ANPRM – CMS Proposed Rules for Liability Medicare Set-Asides

As you should know, Medicare has taken its first steps toward requiring Medicare Set-Asides in all personal injury cases.  On June 15, 2012, it (via CMS and HHS) posted a request for public comment on rules it hastily created for a potential LMSA system.  Our initial analysis of the federal register posting from June 15 […]

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Medicare Advantage Plan Liens & Reimbursement

Medicare Advantage Plans often claim liens and/or reimbursement rights on personal injury lawsuits.  This post isn’t about Medicare Advantage (“MA”) plan reimbursement rights (or whether the Medicare Secondary Payer statute allows federal actions for MA plans).  Instead, this post aims to assist in reduction of MA plan liens. Last week, we were offered a 25% […]

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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 […]

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