MSP + FCA = Big Trouble for Insurers as NJ Federal Court Allows False Claims Action Based on Medicare Secondary Payer Violation

Rafael Gonzalez, Esq. Vice President, Strategic Solutions, Helios On March 1, 2016, the United States District Court for the District of New Jersey published its opinion on Negron v. Progressive Casualty Insurance Company, finding that based on the claim filed pursuant to the Medicare Secondary Payer Act and False Claims Act, Negron has sufficiently plead … Read moreMSP + FCA = Big Trouble for Insurers as NJ Federal Court Allows False Claims Action Based on Medicare Secondary Payer Violation

We Knew it was Coming! CMS is Using Mandatory Insurer Reporting Data to Project Medicare Set Aside Allocations Amount

Rafael Gonzalez, Esq. Vice President, Strategic Solutions, Helios The Medicare Secondary Payer Act (MSP) requires liability insurance (including self-insurance), no-fault insurance and workers’ compensation insurance to report claims specific information mandated by Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173). From the very beginning, the Centers for Medicare … Read moreWe Knew it was Coming! CMS is Using Mandatory Insurer Reporting Data to Project Medicare Set Aside Allocations Amount

CMS Announces It has Issued more than 33,000 CPLs and CPNs Since October 1, 2015; More Are Coming!

Rafael Gonzalez, Esq. Vice President, Strategic Solutions, Helios As we have previously informed here, “in October 2015, the Centers for Medicare & Medicaid Services’ (CMS) Commercial Repayment Center (CRC) assumed responsibility for the recovery of conditional payments where CMS is pursuing recovery directly from a liability insurer (including a self-insured entity), no-fault insurer or workers’ … Read moreCMS Announces It has Issued more than 33,000 CPLs and CPNs Since October 1, 2015; More Are Coming!

CMS Publishes Latest Version of Work Comp MSA Reference Guide

Rafael Gonzalez, Esq.Vice President, Strategic Solutions Dated December 14, 2015, the Center for Medicare and Medicaid Services (CMS) recently published its updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, Version 2.4. First published in March 2013, and since revised on November 2013 (version 2.0), February 2014 (version 2.1), April 2014 (version 2.2), January 2015 … Read moreCMS Publishes Latest Version of Work Comp MSA Reference Guide