Synergy Blog

From Roger Baron: Cert Denied in GSK v. Humana Case Involving Medicare Advantage Plan’s Recovery Rights

Reprinted with Permission from Roger Baron

Today the Supreme Court denied the Petition for Writ of Cert filed in response to the 3rd Circuit’s decision which permits private “Medicare Advantage” insurers to utilize the federal statute [Medicare Secondary Payer Act, 42 U.S.C. 1395y(b)(2)] to pursue a federal cause of action for subrogation.  The 3rd Circuit’s decision is not only problematic for insureds, it also permits subrogation recoveries to be channeled into the pockets of the private insurers, as well as Rawlings and the other subro collection agents.

To view the Petition which was denied click HERE.  Below is the message which Mr. Baron sent out about this case on December 7, 2012.

As most of you are aware, the 3rd Circuit recently decided that private insurers offering Medicare Advantage coverage were permitted to utilize the federal statute [Medicare Secondary Payer Act, 42 U.S.C. 1395y(b)(2)] to pursue a federal cause of action for subrogation.  This decision was a “first of its kind” and, in my opinion, somewhat outrageous because it permits the subrogation recoveries to be channeled into the pockets of the private insurers, as well as Rawlings and the other subro collection agents.

The 3rd Circuit’s ruling is now being challenged in the Supreme Court.  The attached Petition for Writ of Cert was filed two days ago.  The attorneys seeking cert are seeking amicus support.  It is probably too short of notice for any of us to muster up an amicus brief in support of this Petition.  But if, by chance, you know of an organization that would like to do so, that would be great.

TESTIMONIALS

“Synergy is our guiding light for deferring our contingent legal fees and planning for retirement. The lawyers at Panter Panter & Sampedro, myself included, have been working with them for over ten years using different methods to defer comp and plan for retirement.”

Brett Panter
Panter, Panter & Sampedro

"I don't think I've directly said "thank you" for helping us with Bridgett’s case. We sent the reduced payment to Medicaid and called Bridgett's mom to tell her approximately how much money was going to be left for Bridgett and she broke down over the telephone. Given only $25k of insurance and a $850k medical bill from the hospital she didn't think Bridgett would ever see a penny."

Tom L. Copeland
Jeffrey Meldon & Associates, P.A.

CMS Proposed Regulations for Civil Penalties for Reporting, Recent Commentary on MSAs and PAID Act Third Thursday Webinar

Join us this month for a special presentation by Synergy Partner Planner, Josh Pettingill to learn more about CMS's new proposed regulations. There have been numerous announcements recently by CMS that can impact trial lawyers' ability to resolve claims in a timely manner. In the past 30 days, CMS has rolled out initiatives for penalties pertaining to Section 111 reporting requirements as well as updated the Medicare Learning Network for medical providers regarding Medicare Set-Asides. This presentation will discuss all of these updates, as well as highlight the Provide Accurate Information Directly (PAID) Act and MSA attestation updates published on the CMS website.  A 15-minute question and answer session will follow.

WordPress Image Lightbox