Tag Archives: Conditional Payments

CMS BCRC and CRC NGHP Town Hall Updates

On April 1, 2021, CMS held its scheduled Town Hall with the Benefits Coordination & Recovery (BCRC) and Commercial Repayment Center (CRC) for Non-Group Health Plans (NGHP).  Although parts of the Town Hall included information that was already disseminated by CMS in the past, there were some specific highlights as noted below. Partial Resolution of […]

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, […]

“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 […]

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 […]

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 […]

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 […]

U.S. v. Stricker

U.S. v. Stricker CV 09-BE-2423-E, 2010 WL 6599489 (D. N.D. Ala., September 30, 2010) In December, 2009, Medicare filed a lawsuit (U.S. v. Stricker) in Federal District Court through which it sued the plaintiff law firms, the defendant corporations and their insurance carriers for their alleged failure to protect its interests regarding conditional payments in […]

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 […]

Hadden v. U.S.

U.S. v. Hadden No. 1:08-CV-10, 2009 WL 2423114 (D. W.D. Ky, Aug. 6, 2009) This case involved a pedestrian plaintiff, Mr. Hadden, who was struck by a utility truck as he was walking on a sidewalk. The accident was caused when an unidentified driver ran a stop sign thereby cutting off the utility truck causing […]

Tomlinson v. Landers & Zaleppa v. Seiwell

Tomlinson v. Landers, No. 3:07-CV-1180-J-TEM, 2009 WL 1117399 (D. M.D. FL April 24, 2009) AND Zaleppa v. Seiwell No. 219 MDA 2009, 2010 WL 4633467 (Pa. Super. Ct., Nov. 17, 2010) In these cases, the primary payer was insisting that the Medicare be a named payee on the settlement check (i.e. “putting Medicare on the […]