CMS Releases Policy Memo Addressing Liability MSAs

The Centers for Medicare and Medicaid Services (CMS) has released a policy memorandum (dated September 29, 2011) pertaining to liability Medicare set-aside (L-MSA) arrangements.

To obtain a copy of CMS’ September 29, 2011 memo, click here.

Per CMS, “[t]he purpose of this memorandum is to provide information regarding proposed Liability Medicare Set-Aside Arrangement (LMSA) amounts related to liability insurance (including self-insurance) settlements, judgments, awards, or other payments (‘settlements’).” Continue reading “CMS Releases Policy Memo Addressing Liability MSAs”

Stanton v. State Farm Mutual Insurance

Stanton v. State Farm Mutual Insurance
Automobile Insurance Company
No. 11-cv-282-JPG-DGW

2011 WL 3678912 (S.D.Ill.Aug. 22, 2011) 

This case involved an attempt by a defendant insurer (State Farm) to include Medicare’s recovery contractor (MSPRC) on the settlement check in relation to the resolution of a wrongful death claim to ensure that Medicare’s interests were properly protected for conditional payments issued by Medicare.

The plaintiff objected and sought a court order from the Illinois state court ruling that the MSPRC need not be included as a payee on the settlement draft.  State Farm filed an interpleader action against the Secretary of the Department of Health and Human Services bringing Medicare into the action. Continue reading “Stanton v. State Farm Mutual Insurance”

Smith v. Marine Terminals of Arkansas & American Home Insurance Company

Smith v. Marine Terminals of Arkansas & American Home Insurance Company
No. 3:09 CV 00027-JLH
2011 WL 3489806 (E.D.Ark.August 9, 2011)

This case involved the settlement of an injury action arising under the Longshore Act.   The parties reached a global settlement of the filed liability suit and workers’ compensation claim for $1M, with the workers’ compensation carrier agreeing to waive its lien.  As the claimant was receiving social security disability benefits and was Medicare eligible at the time of the settlement, the parties decided to include a Medicare Set Aside (“MSA”) as part of the settlement.

A MSA allocation in the amount of $14,647.00 was secured from a MSA vendor and submitted to CMS for review and approval.  However, CMS ultimately declined to review the MSA proposal citing “workload threshold” reasons.  After CMS declined to review the MSA, the parties filed a joint Motion to Determine Set Aside Amount in the United States District Court for the Eastern District of Arkansas.  Continue reading “Smith v. Marine Terminals of Arkansas & American Home Insurance Company”

Phillips v. Kaiser Health Plan, Inc.,

Phillips v. Kaiser Health Plan, Inc., et. al.
No. C 11 – 02326 CRB
2011 WL 3047475 (N.D.Cal.July 25, 2011)

This case involved a putative class action filed against Kaiser Health Plan, Inc. (Kaiser), a Medicare Advantage (MA) Plan, and other related MA entities. 

The plaintiff alleged that (a) Kaiser was improperly and “illegally” demanding reimbursement of its accident related medical expenditures in an amount greater than that which would have been recoverable under traditional Medicare, and (b) that certain marketing and business practices employed by Kaiser violated California’s Unfair Competition Law and Consumer Legal Remedies Act.

The plaintiff filed this case in California state court, which Kaiser removed to the United States District Court for the Northern District of California (hereinafter referred to as the “court”).   This case then came before the court on (a) the plaintiff’s motion to remand and (b) Kaiser’s motion to dismiss.  Continue reading “Phillips v. Kaiser Health Plan, Inc.,”

Trezza v. Trezza

Trezza v. Trezza
No. 39553, 2011 WL 2640794
(N.Y. Sup. June 23, 2011)

In this case, the Supreme Court of New York, Kings County (the Supreme Court is actually the lower court in New York) ruled that the subject Medicare Advantage (MA) Plan in this action was not entitled to reimbursement for accident related medical expenses it provided. Continue reading “Trezza v. Trezza”