On January 27, 2017, MMM&K partner, Jennifer Creedon spoke on a panel for The Knowledge Group, entitled The Latest Medicare Advantage Decisions: Their Significance and Loopholes, Analyzed. Jennifer gave an overview of the various parts of Medicare and addressed recent decisions impacting parties’ rights and compliance requirements.
For example, in 2012, the Third Circuit expanded the rights of Medicare Advantage Organizations (“MAOs”), or private insurance companies who administer Medicare C plans, by allowing MAOs to pursue a private right of action under the Medicare Secondary Payer Act and receive double damages for a third party payer’s failure to reimburse medical expenses. Additional, a critical regulation, Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007, requires that settlements, judgments, awards or other payments to Medicare beneficiaries be reported to the U.S. Department of Health and Human Services’ Center for Medicare & Medicaid Services. This responsibility now lies on the payer and the government can impose a fine of up to $1,000/day per claim not reported.
As a result, a company must be vigilant in discovery to seek MAO / Medicare C and D payment information. The information gathering process should begin immediately upon learning that the claimant is a Medicare beneficiary. Attorneys should consider asking whether the plaintiff is a Medicare Part C or D Plan recipient in written discovery, confirming the specific Medicare plan at the plaintiff’s deposition, and modifying release language.
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