Medicare Advantage Plans (Part C)

Picture of Lady of Justice Statute

Medicare Advantage Organization Recovery Rights

In published opinion filed on March 18, 2019, the United States Court of Appeals for the 11th Circuit affirmed the district court’s dismissal of MSPA Claims 1, LLC (MSPA) for failure  to sue a “primary plan” pursuant the private cause of action provisions in the Medicare Secondary Payer Act (MSP Act). In MSPA Claims1, LLC […]

CMS Hosts MSPRP Electronic Payment Enhancement Webinar

The March 13, 2019 webinar offered by CMS provided a description of the new direct payment features available through the Medicare Secondary Payer Recovery Portal (MSPRP) as of April 1, 2019.  CMS will be releasing presentation slides within five (5) to seven (7) days and will also be releasing the audio recording thereafter.  Some of […]

CMS Announces Webinars for MSPRP and CRCP Electronic Payment Options

CMS will be hosting two webinars to review the addition of a new electronic payment option that will be added to the Medicare Secondary Recovery Portal (MSPRP) and the Commercial Repayment Portal (CRCP) effective April 1, 2019.  The webinars will include opening remarks followed by a presentation on the new electronic payment functionality. The MSPRP […]

Construction Claims and Medicare Secondary Payer Compliance – Construction Claims Fall Edition 2018

Construction claims present unique and complicated Medicare Secondary Payer statute (“MSP”) issues. Often such claims involve multiple defendants – each of whom may have different levels of involvement and responsibility for underlying claims. Each claim may follow a different timeline, with some claims settling early and others lingering for years. Not to mention that each […]

A Look at the Privatization of Medicare Part A and B Coverage and the MSP Act

Medicare has been in the news lately with the Speaker of the House, Paul Ryan, renewing a push to change the nature of the traditional, fee-for-service Medicare system. To understand the potential impact of a change a review of the background of Medicare is appropriate. Medicare is a Federal health insurance program that was enacted […]

Phillips v. Kaiser Health Plan, Inc., et.al.

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 […]

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 […]

Humana Medical Plan, Inc. v. Mary Reale & Parra v. Pacificare of Arizona, Inc.

Humana Medical Plan, Inc. v. Mary Reale No. 10-21493-Civ., 2011 WL 335341 Jan. 31, 2011 (D. S.D. Fla, January 31, 2011) AND Parra v. Pacificare of Arizona, Inc. No. CV 10–008–TUC–DCB, 2011 WL 1119736 (D. Arizona, March 28, 2011) The main issue presented in these cases involved whether Medicare Advantage Plans could assert their recovery […]