Source: https://www.medicareadvocacy.org/old-site/InfoByTopic/MedicareSecondaryPayer/SecondaryPayerMain.htm
Timestamp: 2019-04-19 08:39:30
Document Index: 308777857

Matched Legal Cases: ['§ 1395', '§ 1862', '§ 411', '§ 411', '§ 411', '§ 411', '§ 1395', '§ 411', '§ 1395', '§ 411', '§ 411', '§ 411', '§ 411', '§ 1395', '§ 411', '§ 1395', '§ 411', '§ 1395', '§ 411', '§ 50', '§ 405', '§ 1395', '§ 411', '§ 40', '§ 40']

THE MEDICARE SECONDARY PAYER PROGRAM
[1] The MSP statute is found at 42 U.S.C. § 1395y(b), Social Security Act § 1862(b). The MSP regulations are at 42 C.F.R. §§ 411.20 et seq.
[2] 42 C.F.R. § 411.50 - 54.
[3] 42 C.F.R. § 411.40 - 47.
[4] 42 C.F.R. § 411.100 - 130.
[5] A series of court decisions interpreted the Medicare statute as not allowing MSP recovery from settlement funds in class action lawsuits. Thompson v. Goetzman, 334 F.3d 489 (5th Cir. 2003); Mason v. American Tobacco Co., 346 F.3d 36 (2d Cir. 2003); U.S. v. Phillip Morris, 116 F. Supp. 2d 131, 145 (D.D.C. 2000). In 2003 Congress overturned these holdings by amending the statute to expand the definitions of self-insured entities and primary plans from which MSP recovery is authorized. See 42 U.S.C. § 1395y(b)(2)(A) and (B).
[6] "Prompt" is defined as within 120 days of the earlier of the date of an insurance claim or the date of medical service. 42 C.F.R. § 411.50(b).
[7] Rybicki v. Hartley, 792 F.2d 260 (1st Cir. 1986); Holle v. Moline Pub. Hosp., 598 F. Supp. 1017 (C.D. Ill. 1984). However, a provider can choose not to bill Medicare but to instead bill a liability insurer or assert a lien on the beneficiary's insurance settlement. Medicare Program: Third Party Liability Insurance Regulations, 68 Fed. Reg. 43940 (2003), modifying 42 C.F.R. 411.54 and 489.20.
[8] 42 U.S.C. § 1395y(b)(2)(B)(ii) - (iv).
[9] 42 C.F.R. § 411.24(h).
[10] 42 C.F.R. § 411.24(c).
[11] Letter of July 3, 2002 from Thomas Bosserman, CMS Region IX Health Insurance Specialist, to Sally Hart.
[12] 42 C.F.R. § 411.37(a)(1) and (d).
[13] 42 C.F.R. §§ 411.21, 411.24(c).
[14] 42 U.S.C. § 1395ff; 42 C.F.R. § 411.28(c)
[15] 42 U.S.C. § 1395y(b)(2)(B)(v); 42 C.F.R. § 411.28(b)
[16] 42 U.S.C. § 1395y(b)(2)(B)(v); 42 C.F.R. § 411.28(a)
[17] MSP Manual, Pub. 100-5, Ch. 7, §§ 50.5.4.4. - 50.7.3.
[18] 42 C.F.R. § 405.926(h).
[19] 42 U.S.C. § 1395y(b)(2)(A); 42 C.F.R. §§ 411.40 - 47.
[20] MSP Manual, supra, Ch. 7, §§ 40.3.4 - 40.3.5.
[21] Procedures for obtaining CMS approval of a set-aside arrangement from the CMS Regional Office are described in the MSP Manual, supra, Ch. 7, at §§ 40.3.5 - 40.3.5.1.
06/04/09 - Medicare Payment for Future Medical Expenses in Tort Cases: CMS Region IX Letter