11th Circuit Brings Clarity to the Statute of Limitations for Medicare Advantage Plans
The 11th Circuit Court of Appeals has attempted to bring some clarity to the statute of limitations in a recent case.
Tag: Medicare Secondary Payer Act
Withdrawal of Long-Awaited Proposed MSP Rules for Liability Cases
October 18, 2022 By: Rasa Fumagalli, JD, MSCC, CMSP-F Medicare has struggled over the years to provide rules clarifying existing Medicare Secondary Payer (MSP) compliance obligations when it comes to post-settlement injury-related care that is released in a liability settlement. Their first attempt at proposed rulemaking took place in 2012 and resulted in the notice […]
Is it Workers’ Compensation or Liability?
Attorneys settling cases involving work-related injuries may find themselves similarly perplexed when it comes to whether a work-related injury will be treated as a workers’ compensation or liability case for purposes of the Medicare Secondary Payer Act (“MSP”).
Navigating the Shifting Landscape of MSP Compliance
The wait for proposed rulemaking related to Medicare Secondary Payer (MSP) compliance obligations regarding future medical services in liability settlements continues. Although the Department of Health and Human Services issued their initial notification of proposed rulemaking in the fall of 2018, the target date has been moved several times and is currently set for October of 2021. However, focusing solely on the notice of proposed rules will cause a practitioner to overlook the impact of important MSP compliance changes taking place with Section 111 Mandatory Insurer Reporting obligations on settlements.
Synergy’s Workers’ Compensation Medicare Secondary Payer Advice Column
October 14, 2021 Rasa Fumagalli JD, MSCC, CMSP-F As we reflect on the 20th anniversary of the devastating September 11, 2001, terrorist attacks on US soil and all the lives lost, we cannot forget the heroic efforts of all the first responders and workers involved in the clean-up of the devastation sites. Since then, many […]
Primary Payer Status Shifts from Liability Carrier to Plaintiff Post-Settlement
Rasa Fumagalli JD, MSCC, CMSP-F In Penelope Stillwell v State Farm Fire and Casualty Co., et al. case (2021 WL 4427081), a plaintiff attempts to impose primary payer status on a liability insurer post-settlement via a qui tam action in federal district court. The U.S. District Court, Middle District of Florida, Tampa Division addressed in […]
Beware of “Conscious Ignorance” Exception to Mutual Mistake Challenge to a Contract
September 9, 2021 Rasa Fumagalli JD, MSCC, CMSP-F The American Bar Association’s Model Rules of Professional Conduct provide a blueprint for attorneys to follow when representing clients. The first Rule and arguably one of the most important ones, outlines a basic expectation in the client-lawyer relationship. Rule 1.1 states: “A lawyer shall provide competent representation […]
Synergy’s Workers’ Compensation Medicare Secondary Payer Advice Column
July 28, 2021 Rasa Fumagalli JD, MSCC, CMSP-F Introducing “Since You Asked,” Synergy’s first in a series of columns addressing MSP compliance questions in the area of workers’ compensation. Question: “My client is settling her case and does not know what to do with her Workers’ Compensation Medicare Set-Aside (WCMSA) funds. I’m not quite sure […]
Exploring Options for Conditional Payment Resolution
July 8, 2021 Rasa Fumagalli JD, MSCC, CMSP-F Most attorneys are well aware of the need to resolve Medicare’s conditional payments in connection with a client’s settlement. This obligation stems from the Medicare Secondary Payer (MSP) Act, 42 U.S.C. § 1395y(b)(2)(A)(ii), which prohibits Medicare from making payment for medical services when “payment has been made […]