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In WOS v. EMA, the first case to reach the US Supreme Court after Ahlborn, the highest Court in the land again examined a state statute requiring up to one-third of any damages recovered by an injury victim to be paid to the state to reimburse it for payments made by Medicaid for injury related treatment.
The SMART Act is a piece of legislation designed to make the Medicare Secondary Payer Act more user friendly. It addresses current issues with the conditional payment recovery process. The legislation has been sitting in the House Energy & Commerce Health Subcommittee for quite some time. On 9/11/12, it passed the committee with markup that has changed some of the key provisions.
On June 6th, I participated in a meeting with CMS officials regarding MSP related issues in Washington, DC. I also spent some time lobbying a couple of members of the House on behalf of the SMART Act.
On April 12th, the Florida Supreme Court ruled on the proposed amendment to rule 4-1.5 and rejected it. What does this mean for lien resolution outsourcing? Read more about it in the post.
Hadden is a case of extreme importance in the field of Medicare conditional payment resolution. Medicare currently does not take into account factors that lead to reduced recovery when resolving conditional payments. Hadden attempted this approach but lost at the Federal District court level and the 6th Circuit Court of Appeals. A Petition for Writ of Certiorari to the US Supreme Court was filed last week.
The MSPRC issues a new alert indicating a $300 low dollar threshold for condtional payment recovery.
The House Energy and Commerce Committee met on 6/22 in response to the SMART Act (reform of the MSP). The purpose of the meeting was to take testimony and to discuss the problems with Medicare’s collection practices in group health plan & Non-group heal plan situations.
The MSPRC’s new RAR letters offers little change, but definitely was altered due to the Haro case in AZ.
The MSPRC announced resumption of RAR letters as of 6/10, but not demand letters.
In Southwest Fiduciary v. Willingham, an Indiana court of appeals ruled that the state’s Medicaid lien on the settlement proceeds must be based upon the actual payments made by Medicaid and not the total amount billed by the healthcare provider.
The MSPRC has temporarily suspended issuance of Rights and Responsibilities letters as well as demand letters. The MSPRC is still working on resolving conditional payments, this is just a hold on issuing the RAR and demand letters.
In sure to be highly litigated issue, Medicare has been enjoined by a United States District Court in Arizona from certain enforcement practices under the MSP.
The Florida Bar, in response to a personal injury lawyer’s request, issues Staff Opinion 30310 finding it unethical for defense counsel to request plaintiff counsel sign a release which includes indemnification/hold harmless language regarding the Medicare Secondary Payer Act.
An Arizona Federal District court finds PacifiCare of Arizona, a Medicare Advantage plan (Part C), does not have a private cause of action to recover payments it made on behalf of an injury victim like Medicare.
The Benson v. Sebelius decision reaches a result opposite to Bradley because medical expenses were claimed in the wrongful death action on behalf of the survivors instead of the estate.
In Alcorn, a federal district court refused the plaintiff’s attempt to bring in CMS to determine the amount of a potential conditional payment obligation prior to a settlement, judgment or award.
Upcoming seminar on Medicare Secondary Payer compliance and I will be presenting.
Medicare’s administrative procedures regarding conditional payments must be exhausted before bringing suit against Medicare. A federal district court lacks subject matter jurisdiction to determine conditional payments prior to judgment, settlement or award AND a final decision is obtained from the Secretary.
HR 1063 was introduced in the 112th Congress by Representative Tim Murphy (R-PA) and Representative Ron Kind (D-WI) on March 14th, 2011. The bill is titled the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act) and it is an attempt to streamline the Medicare conditional payment resolution process.
An Arizona Court of Appeals held that Ahlborn is applicable to reduce Arizona Medicaid’s recovery of a lien against a 3rd party tort recovery.
A federal district court in Virginia rules that Medicare regulations do not pre-empt a state law motion to enforce a settlement. The defendant refused to pay a settlement claiming CMS had not sent written confirmation of the amount it was entitled to for conditional payments made on behalf of the plaintiff.
A class action has been certified as it relates to application of Ahlborn to Missouri Medicaid liens.
Ohio addresses the issue of indemnification, by a plaintiff attorney, of a third party’s interests in settlement proceeds
A Florida Circuit Court Follows Ahlbornand significantly reduces Medicaid Lien
Favorable decision for the plaintiff brought under 1983 seeking an Ahlborn reduction.
The Forkey decision reaches the opposite result from Bradley in terms of the priority of competing claims between a death beneficiary and Medicare.
Due to mandatory insurer reporting of settlements with Medicare beneficiaries pursuant to Section 111 of the MMSEA, many insurers are inserting indemnification clauses into settlement agreement and releases. This NYC Bar opinion addresses whether it is permissible for defense counsel to request plaintiff counsel to sign off on a release with an indemnification clause.
PA court holds MSPA does not require Medicare on the check.
In U.S. v. Stricker, the government’s claims against personal injury attorneys, corporations and insurers which settled a mass tort suit without resolving Medicare conditional payments were held to be time barred because they were not filed within the, arguably, applicable six year statute of limitations.
In Bradley v. Sebelius, the 11th Circuit Court of Appeals approved a probate court’s equitable distribution findings to reduce a Medicare conditional payment obligation.
In a sure to be cited case, a Federal Judge in the Eastern District of Pennsylvania follows the Ahlborn decision and cuts a Medicaid lien by more than 50%.
This is a summary of the Florida post-Ahlborn case law.
The Price decision illustrates the need to present evidence, at a hearing, regarding the total value of an injury claim for purposes of an Ahlborn reduction.
Armstrong v. Cansler affirms the Andrews v. Haygood decision that NC's Medicaid lien statute does not violate the US Supreme Court's holding in Ahlborn.
The Florida Bar committee looking at lien resolution outsourcing has a new proposed rule to govern fees. It allows a lawyer to outsource if that is disclosed in the initial fee contract and the fees must be reasonable.
Plaintiff attempted to use Ahlborn to argue for an allocation hearing before the trial court.
Florida has a statutory reduction formula for Medicaid liens.
Medicare will not pay for certain treatment related to medical malpractice
Medicare Secondary Payer Enhancement Act of 2010
