You Are Being Watched

All non-group health plans (NGHP) including all property & casualty insurers who insure auto no-fault (Med Pay/PIP) claims, workers’ compensation claims, premises Med Pay claims, get your assumption and/or termination of ongoing responsibility for medicals (ORM) reporting in order, a firm called MSP Recovery is coming after you. A recent 11th Circuit decision in MSPA … Read moreYou Are Being Watched

The SPARC Act and Compliance with Medicare Advantage plans PART D prescription drugs

In September, Congressman Tim Murphy (R-PA) and Congressman Ron Kind (D-WI) introduced bipartisan legislation into the U.S. House of Representatives to improve the Medicare Secondary Payer (MSP) Act as it pertains to the Medicare Prescription Drug (Part D) program. The Secondary Payer Advancement, Rationalization and Clarification (SPARC) Act (H.R. 6120) would clarify the Part D … Read moreThe SPARC Act and Compliance with Medicare Advantage plans PART D prescription drugs

Centers for Medicare & Medicaid Services announces annual recovery thresholds for certain liability insurance, no-fault insurance and workers’ compensation payments

To fulfill the requirements of Section 202 of the Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2012, Centers for Medicare & Medicaid Services (CMS) is required annually to review all of the costs related to collecting data and determining the amount of Medicare’s recovery claim, otherwise known as conditional payments. As of September 26, … Read moreCenters for Medicare & Medicaid Services announces annual recovery thresholds for certain liability insurance, no-fault insurance and workers’ compensation payments

New York Federal District Court Reminds that CMS Right to Reimbursement of Conditional Payments from Beneficiaries Accrue Only After a Primary Payment

On July 11, 2016, the United States District Court for the Eastern District of New York published its opinion on Sexton v. Medicare, concluding the Court lacked subject matter jurisdiction over plaintiff’s claim; thereby granting the Secretary of the United States Department of Health and Human Services (HHS) motion to dismiss. The Court reminds us … Read moreNew York Federal District Court Reminds that CMS Right to Reimbursement of Conditional Payments from Beneficiaries Accrue Only After a Primary Payment