In a highly anticipated case that many thought had a chance to be heard by the US Supreme Court, Hadden v. US was denied certiorari on 10/1/12. This leaves standing the 6th Circuit’s ruling that Medicare may seek full reimbursement even when Mr. Hadden only recovered 1/10th of his total damages.
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.
For settlements of $5,000 or less there is now an option to pay 25% of the settlement proceeds to Medicare to resolve the conditional payments regardless of the amount of the payments made by Medicare.
On 10/17/11, Senators Wyden (OR) and Portman (OH) introduced the SMART Act.
New MSPRC self service feature announced.
The MSPRC issues a new alert indicating a $300 low dollar threshold for condtional payment recovery.
On June 27th, Medicare formally resumed issuing demand letters after it halted issuance in response apparently to the Haro v. Sebelius decision. I will summarize what is new in the demand letter.
In Wilson v. State Farm Mutual, a Kentucky federal district court found there was no bad faith where the insurer refused to pay a settlement until Medicare made a determination on the amount of the repayment obligation for conditional payments.
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.
Defendants increasingly want to put Medicare on the check.