Monthly Archives: May, 2018

Medicare Lien Surprise: Don’t Ever Rely on a Conditional Payment Letter

An intriguing case, Mayo v NYU Langone Med. Ctr., just came out of the Supreme Court of New York, reminding the trial bar that when resolving a conditional payment for a Medicare beneficiary only the “Final Demand” letter is final.  Reliance upon a “Conditional Payment Letter” (CPL) is inappropriate.  The Mayo case revolved around whether…

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Big Data and Medicare – Recipe for Disaster

B. Josh Pettingill, MBA, MS, MSCC Introduction A vital step to navigating the MSP statute is understanding the dynamics between the Section 111 Reporting Requirement and the potential interplay for a Liability Medicare Set Aside (LMSA). The MSP statute precludes Medicare from paying for any item or service when payment has been made by a…

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Medicare Advantage Private Cause of Action is Now Sweeping the Country

Medicare Advantage Private Cause of Action is Now Sweeping the Country Courts across the country continue to rule that Medicare Advantage Plans (MAP or MAO) are enforceable and shall be entitled to double damages if not repaid in third party liability situations.  The trial bar has been aware of this significant exposure since 2016 when…

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