CUTTING EDGE INDUSTRY THOUGHT LEADERSHIP INSIGHTS

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.

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 9^th Circuit have done little to eliminate this confusion.  Instead, the latest
case law has increased the complexity.

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In WOS v. EMA, the first case to reach the US Supreme Court after Ahlborn, the highest Court in the land again examined a state statute requiring up to one-third of any damages recovered by an injury victim to be paid to the state to reimburse it for payments made by Medicaid for injury related treatment.

Are the defendants/insurance carriers throwing everything but the kitchen sink into your release language in regards to protecting Medicare’s interests?

On December the 19^th the Strengthening Medicare Secondary Payer Rules Act was passed by the House.   The Senate passed the Act on December the 21^st.  It is on its way to President Obama to sign.  While it modifies the Medicare Secondary Payer Act, it only streamlines the MSP conditional payment process and has nothing to do with Medicare Set Asides. 

With Medicare Secondary Payer (“MSP”) Compliance on everyone’s minds these days, it is no wonder that MSP vendors have tried to capitalize on these fears by offering services targeting them.  The problem is that some of these vendors may be doing more harm than good.