Feds pursuing Medicare conditional payment reimbursement from beneficiaries’ attorneys, as well as primary payers

Although we hear a great deal about Medicare becoming increasingly more aggressive with primary payers (responsible employers, corporations, insurers, self insured entities, and third party administrators), the federal government is also becoming just as unforgiving with beneficiaries’ attorneys. Pursuant to the Medicare Secondary Payer provisions of the Social Security Act, 42 U.S.C. § 1395y(b)(2), when Medicare … Read moreFeds pursuing Medicare conditional payment reimbursement from beneficiaries’ attorneys, as well as primary payers

FDA requires label changes for opioid analgesics to guide prescribers when gradual tapering is needed

This is a crosspost from the Optum Insights blog. The U.S. Food and Drug Administration (FDA) issued a safety communication in early April that requires changes to prescribing information for opioid analgesics used in outpatient settings. The goal is to expand the information available to health care providers and patients when opioid analgesics have been … Read moreFDA requires label changes for opioid analgesics to guide prescribers when gradual tapering is needed

FDA creates faster way to access over-the-counter naloxone products to treat opioid overdoses

The following is cross-posted from our Optum Insights—Government Affairs blog The U.S. Food and Drug Administration (FDA) recently established a more rapid path for pharmaceutical companies to add over-the-counter (OTC) naloxone products to the market to increase access to naloxone – a life-saving medication used for the emergency treatment of opioid-related overdose – and help … Read moreFDA creates faster way to access over-the-counter naloxone products to treat opioid overdoses

Despite settlement agreement, primary payer receives request for reimbursement

On August 6, 2018, in the United States District Court for the District of South Carolina, Florence Division, Humana Insurance Company (Humana) brought an action against Bi-Lo, LLC (Defendant), a Delaware limited liability company that sells groceries in the southeastern region of the United States. Humana’s action is for declaratory judgment to recover double damages pursuant the Medicare Secondary Payer Act (MSP) in the amount of $32,754.02 due and owing to Humana, as a Medicare Advantage Organization (MAO), by virtue of payments made on behalf of one of its enrollees, a Medicare beneficiary who elected Medicare Advantage coverage from Humana. This occurred despite the existence of a settlement agreement in which the enrollee and her counsel agreed to be responsible for such reimbursement. However, because the enrollee/counsel did not reimburse the Medicare payments advanced by Humana, Humana again seeks reimbursement from the Corporate Defendant.

Read moreDespite settlement agreement, primary payer receives request for reimbursement