Heather Schwartz Sanderson, Esq., MSCC, CHPE, CLMP, CMSP Heather is Chief Legal Officer for Franco Signor LLC, the nation's compliance authority for Medicare Secondary Payer (MSP) matters. She has lectured on MSP compliance to the workers’ compensation and liability insurance communities at conferences, associations, and individual offices nationwide. She is a regularly published author on court decisions and legislative reforms involving Medicare Set-Asides, conditional payments, and Mandatory Insurer Reporting issues. Understanding that compliance with the Medicare Secondary Payer Act can be at times complex and frustrating for those that handle claims with Medicare beneficiaries, Heather’s goal is to speak and write with the primary goal being simple and understandable solutions to compliance. Heather can be reached at Heather.Sanderson@francosignor.com Franco Signor's Blog can be found at: http://www.francosignor.com/msp-blog/

---

Ninth Circuit Concludes Judgment in Favor of CIGA as a Guaranty Fund Not Subject to MSP Obligations

• 03/11/20

As we had blogged about last October, the 9th Circuit in CIGA v. Azar held that CIGA as a Guaranty Fund was not a “primary plan” under the MSP, due to the fact that CIGA pays for ...
Read More

11th Circuit: Medicare Advantage Organizations Not Precluded by the MSP 3-year Claim Filing Provision

• 02/27/20

In a decision out of the Eleventh Circuit, MSPA Claims v. Kingsway Amigo, 2020 U.S. App. LEXIS 4554 (February 13, 2020), Plaintiff MSPA Claims (aka MSP Recovery LLC) was able to persuade the Court that the ...
Read More

CMS Updates NGHP Guide with 2020 MSP Recovery Thresholds

• 02/11/20

As of January 31, 2020, CMS updated its NGHP User Guide to version 5.8 to include the 2020 MSP Recovery Thresholds. The updated NGHP User Guide Version 5.8 can be found here.  As we had blogged on in ...
Read More

Top Medicare Secondary Payer Predictions for 2020

• 01/17/20

Medicare Secondary Payer (MSP) developments will take center-stage in 2020 and drastically impact workers’ compensation, no-fault, and general liability insurance plans/carriers. With 2020 being an ...
Read More

CMS Updates WCMSA Reference Guide

• 10/31/19

CMS has released an updated WCMSA Reference Guide version 3.0. It can be found here. The two significant changes are 1) CMS extending the Amended Review period from 4 to 6 years (Section ...
Read More

9th Circuit Court of Appeal Rules that CIGA, a Guaranty Fund, is not Subject to Medicare Secondary Payer Act Obligations

• 10/14/19

Franco Signor has been following the CIGA (California Insurance Guaranty Association) litigation filed against HHS/CMS for some time. CIGA is California’s largest workers’ compensation provider ...
Read More

South Carolina District Court "Joins Sister Courts" in Allowing MAOs to Maintain an MSP Double Damages Private Cause of Action Against Primary Plans

• 09/26/19

Recall last year in 2018 we blogged that Humana Medicare Advantage had filed an action against Bi-Lo, LLC, a grocery retailer, in the U.S. District Court for the District of South Carolina for declaratory ...
Read More

WCMSA Legislation Introduced Again in U.S. House of Representatives

• 08/22/19

We have blogged on numerous occasions regarding Workers’ Compensation Medicare Set-Aside (WCMSA) legislation that continues to be re-introduced in Congress with slight variations over the last decade ...
Read More

District Court Indicates That First Circuit May Allow Medicare Advantage Organizations to Sue Primary Payers for Double Damages under the MSP Act

• 07/24/19

The Wild Wild West of Medicare Advantage Organizations (MAOs) filing litigation nationwide against primary plans (workers’ compensation, liability or no-fault carriers/plans) to establish the right to ...
Read More