MSPRC Announces Electronic Submission Portal

The Medicare Secondary Payer Recovery Contractor (MSPRC) has announced plans to implement a web-based electronic submission portal.

The MSPRC is launching a pilot program to test their new portal in the upcoming months with a projected “go live” date in July, 2012. This portal will facilitate and expedite the conditional payment process for Liability Insurance, No-Fault Insurance, and Workers’ Compensation cases. In addition, it will enable adjusters to electronically submit their Authorizations and Consent to Release documentation, request conditional payment information, negotiate unrelated items from the conditional payment worksheet, and provide settlement information to release the conditional payment demand.   Click on this link to view the announcement from the MSPRC website directly:  http://www.msprc.info/

“Self-Calculated Final Conditional Payment Amount” Option

The Centers for Medicare & Medicaid Services (CMS) will be implementing an option that will allow certain Medicare beneficiaries to obtain Medicare’s final conditional payment amount prior to settlement. This option will be available in February 2012, for certain settlements involving physical trauma based injuries where treatment has been completed. Under this option, the beneficiary or his representative will calculate the amount of Medicare’s conditional payment amount using information received from the Medicare Secondary Payer Recovery Contractor (MSPRC), the MyMedicare website, or other claims information available to the beneficiary. The MSPRC will review this amount and, if finding the amount accurate, will respond with Medicare’s final conditional payment amount within 60 days. To secure the final conditional payment amount, the beneficiary must settle within 60 days after the date of Medicare’s response. Continue reading ““Self-Calculated Final Conditional Payment Amount” Option”

The SMART Act Is Introduced in the United States Senate

On October 17, 2011, the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act) was introduced in the United States Senate by Senators Ron Wyden (D-OR) and Rob Portman (R-OH). The Senate bill number is S. 1718.

The SMART Act was previously introduced in the United States House of Representatives in March 2011 by representatives Ron Kind (D-WI) and Tim Murphy (R-PA). The House bill number is H.R. 1063.

The SMART Act proposes major amendments to the Medicare Secondary Payer Statute (MSP) in a number of areas, including MMSEA Section 111 reporting and conditional payment recovery.

A detailed overview of the proposals contained in the SMART Act is outlined in NuQuest/Bridge Pointe’s Settlement News (March 2011), a copy of which can be obtained here. http://dev.nqbp.com/sites/default/files/March2011SettlementNews.pdf

To chart the progress of the SMART Act in Congress, the reader may wish to consult the following resources http://www.govtrack.us/congress/billtext.xpd?bill=h112-1063

or http://marccoalition.com/MSP_Reform.html

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”

Benson v. Sebelius

Benson v. Sebelius
Civil Action No. 09-1931 (RMU),
2011 WL 1087254
(D. D.C. March 24, 2011)

This case involved a wrongful death and survival action. The parties settled the claim for $90,000, with 80% of that amount allocated for the wrongful death settlement award and 20% allocated for the survival claim. Medicare issued a final demand for conditional payment recovery in the amount of $25,868.58.

Benson challenged Medicare’s recovery claim arguing that under the Medicare Secondary Payer Statute (MSP) CMS can only recover from that aspect of the settlement related to the Medicare beneficiary’s estate and not from the wrongful death part of the settlement per the per the court’s decision in Bradley v. Sebelius, 621 F.3d 1330 (11th Cir., Sept. 29, 2010). In addition, Benson contended that one of the administrative bodies’ alleged failure to provide him with a requested transcript in a timely manner during the administrative appeals phase of the action violated his 5th Amendment due process rights.

The court rejected the plaintiff’s arguments and ruled in favor Medicare. In reaching its decision that court found the Benson case was factually and legally different from Bradley. For reasons more fully explained in the court’s ruling, the court, in part, found that Medicare could recover its full claimed amount in that in Benson (unlike in Bradley) the plaintiff claimed compensation for the decedent’s medical costs as part of his wrongful death claim. The court also found that there was no violation of 5th Amendment due process rights.