Tag Archives: Medicare

Confusion, Conjecture and Clarification: The New WCMSA Reference Guide

With the issuance of updated Workers’ Compensation Medicare Set-Aside Reference Guide version 2.9 (Guide), there has some speculation and even confusion as to what is really new and what is an elaboration of old policies and procedures.  Examples listed for off-label drug usage to new bullets added regarding the submission process, all of which begs […]

nurse explaining to a eldery woman what is on an ipad device

The OMB Issues Intent of Notice of Proposed Rule Making for Section 111 Penalties

In an abstract entitled “Civil Money Penalties and Medicare Secondary Payer Reporting Requirements,” the Office of Management and Budget has issued another intent of Notice of Proposed Rulemaking this time involving Section 111 Reporting penalties.  Specifically, the abstract of the Notice provides as follows: Section 516 of the Medicare Access and CHIP Reauthorization Act of […]

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 […]

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 […]

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 […]

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 […]

ArvinMeritor, Inc. v. Clifton Johnson

ArvinMeritor, Inc. v. Clifton Johnson CV 2090822, 2011 WL 751925 (Ala. Civ. App., Feb 25, 2011) This case involved an Alabama workers’ compensation claim filed in 1999.  In February 2003, the trial court found the claimant 100% permanently disabled as a result of an occupational disease and issued a judgment requiring the employer to pay […]

Smith v. Sound Breeze Condo Association of Groton

Smith v. Sound Breeze Condo Ass’n of Groton No. KNLCV 095012261s, 2011 WL 803067 (Ct. Sup. Ct., Feb. 3, 2011) In this case, the RRE requested permission to file a set of non-standard interrogatories to obtain the plaintiff’s name, address, social security number, birth date and gender so that it could determine Medicare status for […]