Synergy’s blog brings you the industry’s foremost thought leadership InSights on matters of healthcare lien resolution and Medicare Secondary Payer Compliance. Visit often to discover helpful InSights on important lien resolution compliance issues.
In a case of first impression at the Federal District Court level, a United States
District Court in the Western District of Louisiana apportions a LMSA and
reduces it due to a limited recovery.
On April 16, 2013, the United States Supreme Court clarified how equitable principles interact with the plan language of self-funded ERISA health plans. The question presented to the Court was: Should the principles of “common fund,” often referred to as a reduction for attorney fees, and “made whole,” the principle requiring full compensation to the injured party before subrogating parties are allowed to recover, overcome express plan language abrogating those principles? Sadly, the Court has ruled that they should not.
Families and individuals injured by Vioxx may still have lien claims to resolve despite the Lien Resolution Administrator’s attempt to manage these claims. In a December 4, 2012 ruling the United States District Court, E.D. Louisiana denied the motion of approximately forty six (46) insurance companies to have their lien claims resolved from the Vioxx settlement fund.
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?
Learn more about the Medicare recovery process under the MSP.
On December the 19th the Strengthening Medicare Secondary Payer Rules Act was passed by the House. The Senate passed the Act on December the 21st. 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.
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. One of the major responsibilities of the plan administrator, as to dealing with the providing of information to beneficiaries, is contained in 29 U.S.C. 1024(b)(4).
Reprinted with permission from Roger Baron
The 8th Circuit Court of Appeals handed down its decision in Treasurer, Trustees of Drury Industries v. Sean Goding, No. 11-2885. This is a situation where the ERISA plan doggedly pursued the law firm which had represented the ERISA beneficiary in securing a tort recovery.