Tag Archive | Healthcare
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 […]
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The United States District Court of New Jersey recently stated (albeit in an Unpublished Opinion) that Federal Law does not mandate Medicare Set-Asides in a liability context.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, […]
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 […]
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 […]
Federal Register – June 15, 2012: Advanced Notice of Proposed Rulemaking (LMSAs)
The Friday, June 15, 2012 Federal Register includes a four-page request for public comment requested by the Department of Health and Human Services’ Centers for Medicare & Medicaid Services. The comment is requested for potential changes to 42 CFR Parts 405 and 411 and is titled, “Medicare Program; Medicare Secondary Payer and ‘Future Medicals.’ “ […]
Lien Resolution Services - Healthcare Lien Resolution Blog 