“Demonstrated Responsibility” under the Medicare Secondary Payer Act: A Contractual Obligation Suffices
Posted on Sep 1, 2016 in Insurance | Comments Off on “Demonstrated Responsibility” under the Medicare Secondary Payer Act: A Contractual Obligation Suffices
In its second major Medicare Secondary Payer (“MSP”) Act decision in a month, the Eleventh Circuit held that an insurer’s contractual obligation, without a judgment or settlement, can provide the “demonstrated responsibility” necessary to allow a claim against the insurer for double damages under the Act. MSP Recovery, LLC v. Allstate Ins. Co., 2016 WL 4525222 (11th Cir. Aug. 30,...
Insurers May Be Liable for Double Damages for Failure to Reimburse Other Insurers Acting as “Medicare Advantage Organizations”
Posted on Aug 10, 2016 in Insurance | Comments Off on Insurers May Be Liable for Double Damages for Failure to Reimburse Other Insurers Acting as “Medicare Advantage Organizations”
A divided panel of the Eleventh Circuit has joined the Third Circuit in holding that not only the government, but also a private insurer acting as a Medicare Advantage Organization (“MAO”), has a right of action for double damages when a primary payer fails to reimburse the MAO for payments the MAO has made. The case includes analysis of several provisions of the Medicare Act and a...