B. Josh Pettingill There is mounting evidence that the Centers for Medicare and Medicaid Services (CMS) will establish formal guidelines for liability MSAs in the imminent future. Medicare Secondary Payor compliance related to future medical care is an issue that can’t be ignored but that doesn’t necessarily mean setting up a Medicare Set-Aside on every […]
Jason D. Lazarus, J.D., LL.M., CSSC, MSCC On March 18, 2019, the United States Attorney for the District of Maryland announced that the law firm of Meyers, Rodbell & Rosenbaum, P.A., has agreed to pay the United States $250,000 to settle claims that it did not reimburse Medicare for payments made on behalf of a […]
Medicare Advantage Private Cause of Action is Now Sweeping the Country Courts across the country continue to rule that Medicare Advantage Plans (MAP or MAO) are enforceable and shall be entitled to double damages if not repaid in third party liability situations. The trial bar has been aware of this significant exposure since 2016 when […]
New Medicare Portal Goes Live January 2016 On November 9th 2015, The Centers for Medicare & Medicaid Services (CMS) announced the much anticipated, and long overdue, start date for the new Medicare Secondary Payer Recovery Portal (MSPRP). The new MSPRP will begin functioning on January 1, 2016. The current MSP Web portal permits authorized users […]
In Humana Medical Plan, Inc. v. Western Heritage Insurance Co., No. 12-20123, 2015 U.S. Dist. LEXIS 31875, the U.S. District Court for the Southern District of Florida granted Humana’s Motion for Summary Judgment and held that Humana’s right to reimbursement for the conditional payments it made on behalf of plan beneficiary under a Medicare Advantage […]
What is the statute of limitations for Medicare to institute an action for repayment of conditional payments used to be a question with more than one answer. In the past the Centers for Medicare and Medicaid Services (“CMS”) had argued that the six (6) year limitation period contained in the Federal Debt Collection Act for […]
An Administrative Services Agreement between a Plan Administrator and a Claims Administrator may fall within the purview of a document request under ERISA 29 U.S.C. § 1024(b)(4), with non-compliance subject to the penalty assessment authorized under ERISA 29 U.S.C. § 1132(c). As Synergy has long advocated, one of the keys to properly defending against an asserted subrogation or reimbursement claim from an ERISA plan is making requests to the plan administrator.
This case involved a Virginia plaintiff who was injured when a shower chair collapsed. The plaintiff had a pre-existing hip injury which involved an implanted prosthetic. Plaintiff’s counsel engaged Synergy Lien Resolution Service to assist in the resolution of the ERISA plan’s reimbursement claim. Despite the unfavorable law in the 4th Circuit, which was recently bolstered by U.S. Airways v.McCutchen, within two (2) weeks Synergy was able to obtain a 70.2% reduction for a savings of $85,955.02.
Medicare Advantage plans, otherwise known as Medicare Part C, have proven to be a hot and confusing topic for plaintiff’s attorneys over the past few years. Recent rulings by the U.S. Supreme Court and 9th Circuit have done little to eliminate this confusion. Instead, the latest
case law has increased the complexity.
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