Medicare Advantage and Double Damages: Another Domino Falls

Medicare Advantage organizations (MAOs) earned another small victory with a favorable ruling on a motion to dismiss out of Federal Court in Boston. The case, MSP Recovery Series, LLC v. Plymouth Rock Assurance Co., represents another in the continued slow march of decisions that afford Medicare Advantage Plans the right to sue primary payers in Federal… Read more »

Medicare Advantage Update: New Case in Connecticut

A new decision from United States federal court in Connecticut opens the door for Medicare Advantage organizations (MAOs) to use the Medicare Secondary Payer statutes private cause of action provision to sue insurers in federal court. The case, Aetna v. Guerrera, involved a lawsuit under the private cause of action against all parties involved in… Read more »

Medicare Advantage Plans Prevail Again Before a Federal Appeals Court

Double Damages and MAPs – What You Need To Know: On August 8, 2016, the U.S. Eleventh Circuit Court of Appeals upheld an order from the lower federal district court granting summary judgment in favor of Humana[i] regarding Western Heritage Insurance Company’s (Western’s) obligation to reimburse Humana for Medicare benefits paid on behalf of its… Read more »

Legal Update on Medicare Advantage Plan Recovery Rights

The latter half of 2014 and, thus far, 2015 have been busy times for Medicare  Advantage Plans (MAPs) seeking clarification of their rights under the Medicare  Secondary Payer (MSP) Act. MAPs, or “Part C providers” argue that the MSP Act  and federal regulations outlining the right of Medicare Advantage Organizations  are broad enough to allow… Read more »

CMS Issues Final Rule Implementing Appeal Provisions of the SMART Act

On Friday, February 27, the Centers for Medicare and Medicaid Services published its final rule implementing provisions of the Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2012 regarding the appeals process for liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws or plans when Medicare pursues a Medicare Secondary Payer (MSP) recovery claim… Read more »