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On August 16, 2018, the US Court of Appeals for the Sixth Circuit remanded Duncan v. Liberty Mut. Ins. Co., 2018 U.S. App. LEXIS 22811, back to the US District Court. The case involved the Medicare Secondary Payer Act (MSPA) and questioned whether a party can pursue double damages under the MSPA. Facts of the...
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Recently, this question was addressed by the Maryland Court of Special Appeals in Netro v. Greater Balt. Med. Ctr., Inc., No. 1990, 2018 Md. App. LEXIS 679 (App. July 5, 2018). In Netro, the Fourth Circuit added to the budding list of jurisdictions addressing who is able to sue under the private cause of action...
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An updated Worker’s Compensation Medicare Set-Aside (“WCMSA”) reference guide has been issued. The revised guide includes: Fields formerly labeled as “HICN” have been labeled as “Medicare ID” and can accept either Health Insurance Claim Number (“HICN”) or the new Medicare Beneficiary Identifier; The link to the CDC Life Expectancy Table has been updated; and The...
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MSP Recovery, LLC, a leading Medicare and Medicaid Secondary Payer Act recovery specialist, today announced that it has successfully completed a System Organization Controls (SOC) 2® Type I Audit examination for their Secondary Payer Recovery Services System. MSP retained international business advisory firm Skoda Minotti for its SOC 2® audit work. MSP selected Skoda Minotti...
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Two recent legal decisions out of the Eleventh Judicial Circuit in and for Miami Dade County indicate that Medicare Advantage Organizations (MAOs) may be able to obtain reimbursement from no-fault liability carriers pursuant to Medicare Secondary Payer law on a class-wide basis. On April 20, 2017, the Honorable Judge Antonio Arzola entered a 56-page order...
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After several wins at the U.S. Court of Appeals for the 11th Circuit, MSP Recovery made history again obtaining class certification for Medicare Advantage Organizations based on the principles of Medicare Secondary Payer law, against IDS Insurance Company. On April 20, 2017, the Honorable Judge Antonio Arzola entered a 56-page Order Granting the Motion to...
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Lawyers: 11th Circuit Medicare Ruling Could Be Worth Billions by Katheryn Hayes Tucker A federal appeals court decision analyzing the Medicare Secondary Payer Act could put the nation’s largest automobile insur­ance companies and other providers on the hook to pay billions of dollars in Medicare reimbursement. “This is a humongous victory,” said John Ruiz of...
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11th Circuit Puts Insurers on the Hook to Repay Billions Eleventh Circuit Court Rules Again in Favor of Medicare Advantage Plans: Contract of Insurance Demonstrates Responsibility to Pay Eleventh Circuit Finds Mere Existence Of Insurance Contract Satisfies Condition Precedent To Action For Double Damages Under The Medicare Secondary Payer Act
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On August 8, 2016, the United States Court of Appeals, in Humana Medical Plan v. Western Heritage, held that the Medicare Secondary Payer Act (“MSP Act”) “clearly indicates” that a Medicare Advantage Organization (“MAO”) may bring a private cause of action” against a primary plan, which completely supports MSP Recovery Law Firm’s (“MSP Recovery”) long-held...
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The Eleventh Circuit Court of Appeals follows the Third Circuit’s lead by finding a Medicare Advantage Organization (MAO) has a private cause of action to pursue reimbursement under the Medicare Secondary Payer Act (MSP). A case of first impression, Humana Med. Plan v. W. Heritage Ins. Co., touched upon whether the MSP private cause of...
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