Liability Medicare Set-Aside (MSA) Case Studies: Eliminate, Reduce & Comply
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 …
Medicare Compliance: A second law firm sued by DOJ for failing to be Medicare compliant
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 …
Medicare Advantage Private Cause of Action is Now Sweeping the Country
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 …
New Medicare Portal Goes Live January 2016
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 …
Humana vs. Western Heritage – Double Damages for Medicare Advantage Plans
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 …
What is the SOL for Medicare Conditional Payments?
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 …
Add the Administrative Services Agreement to your ERISA Document Request
By Director of Lien Resolution
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 …
Synergy reduces self-funded ERISA plan by over 70% for a savings of $85,955.02
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. The plaintiff retained the services of an attorney and was able to obtain $525,000.00 …
Medicare Advantage Plan’s Statutory Recovery Rights – Private Cause of Action?
By Synergy Director of Lien Resolution
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 …
WOS v. EMA – US Supreme Court Strikes Down North Carolina’s Medicaid Third Party Liability recovery statute and reaffirms Ahlborn
By Jason D. Lazarus, J.D., LL.M, MSCC, CSSC
Since the landmark decision by the US Supreme Court in Arkansas Department of Health and Human Services v. Ahlborn in 2006, state Medicaid agencies have grappled with how to recover monies spent …
