Humana vs. Western Heritage – Double Damages for Medicare Advantage Plans
In Humana Medical Plan, Inc. v. Western Heritage Insurance Co., No. 12-20123, 2015 U.S. Dist. LEXIS 31875, the U.S. District Court for the Southern District of Florida granted Humana’s Motion for Summary Judgment and held that Humana’s right to …
What is the SOL for Medicare Conditional Payments?
What is the statute of limitations for Medicare to institute an action for repayment of conditional payments used to be a question with more than one answer. In the past the Centers for Medicare and Medicaid Services (“CMS”) had argued …
Add the Administrative Services Agreement to your ERISA Document Request
By Director of Lien Resolution
An Administrative Services Agreement between a Plan Administrator and a Claims Administrator may fall within the purview of a document request under ERISA 29 U.S.C. § 1024(b)(4), with non-compliance subject to the penalty assessment authorized …
Synergy reduces self-funded ERISA plan by over 70% for a savings of $85,955.02
This case involved a Virginia plaintiff who was injured when a shower chair collapsed. The plaintiff had a pre-existing hip injury which involved an implanted prosthetic. The plaintiff retained the services of an attorney and was able to obtain $525,000.00 …
Medicare Advantage Plan’s Statutory Recovery Rights – Private Cause of Action?
By Synergy Director of Lien Resolution
Medicare Advantage plans, otherwise known as Medicare Part C, have proven to be a hot and confusing topic for plaintiff’s attorneys over the past few years. Recent rulings by the U.S. Supreme Court and …
WOS v. EMA – US Supreme Court Strikes Down North Carolina’s Medicaid Third Party Liability recovery statute and reaffirms Ahlborn
By Jason D. Lazarus, J.D., LL.M, MSCC, CSSC
Since the landmark decision by the US Supreme Court in Arkansas Department of Health and Human Services v. Ahlborn in 2006, state Medicaid agencies have grappled with how to recover monies spent …
Medicare Secondary Payer Language in Your Release: Problems?
Are the defendants/insurance carriers throwing everything but the kitchen sink into your release language in regards to protecting Medicare’s interests? Be careful what you agree to include in the settlement documents. It can potentially cause a loss of itemized medical …
Understanding the MSPRC Process
By Tal A. Wollschlaeger
Medicare Lien Analyst
Everybody expects to get paid back one way or another. Whether someone owes you money because you bought him or her lunch when times were tough or you owe money on your credit …
US Congress Passes the Strengthening Medicare Secondary Payer Rules Act: Will it Help?
By Jason D. Lazarus, J.D., LL.M., MSCC, CSSC
On December the 19th the Strengthening Medicare Secondary Payer Rules Act was passed by the House. The Senate passed the Act on December the 21st. It is on its …
Medicare Secondary Payer Recovery Portal is Live
The Medicare Secondary Payer Recovery Portal is Live!
A new online Self-Service Tool to help manage your Medicare recovery case.
The Centers for Medicare & Medicaid Services (CMS) has implemented a new web-based tool designed to assist in the resolution …
