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.,”

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.

Bradley v. Sebelius

Bradley v. Sebelius
621 F.3d 1330
(11th Cir., Sept. 29, 2010)

This case involved a wrongful death action filed under the Florida Wrongful Death Act for alleged nursing home neglect. The decedent (Mr. Burke) was survived by 10 children. One of his daughters (Cardonvella Bradley) was named personal representative of the estate.

Bradley filed a wrongful death action against the nursing home through which damages were claimed for the estate and the ten surviving children per Florida law. The action was eventually settled without a formal action being filed in court for the nursing home’s policy limits — $52,500. This sum was undifferentiated between the parties.

Medicare asserted a conditional payment claim in the amount approximately $22.480.89 (with said figure representing the full amount of Medicare’s conditional payments minus applicable procurement costs). Bradley requested that Medicare reduce its claim on various grounds. Medicare refused and demanded a full recovery. Continue reading “Bradley v. Sebelius”

U.S. v. Harris

U.S. v. Harris
No. 5:08 CV 102, 2009 WL 891931
(D. N.D. W. Va., March 26, 2009)

This case arose from an incident in which Mr. Ritchea fell off a ladder. Mr. Richea hired Mr. Harris as his attorney to represent him on his personal injury claim. Mr. Harris filed an action against the ladder retailer which eventually settled for $25,000.

As Mr. Ritchea was a Medicare beneficiary, Mr. Harris notified Medicare of the settlement and requested their conditional payment demand figure. In response, Medicare made a conditional payment recovery demand in the amount of $10,253.39 and advised that any appeal had to be filed with 120 days. Neither Mr. Ritchea nor Mr. Harris tendered reimbursement or filed an appeal. Medicare then sued Mr. Harris for reimbursement of its conditional payment amount. Continue reading “U.S. v. Harris”