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/

---

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

Subsequent to $2.4M Pay Out, Progressive Continues to face NJ State False Claims Act Litigation

• 06/21/19

Over the last several years, we have been providing updates regarding False Claims Act (FCA) litigation, filed both in Federal and NJ court, against Progressive Insurance Company, wherein a whistleblower, a ...
Read More

Settlements with "Reasonably Expected" Medicare Beneficiaries: What are the WCMSA Requirements?

• 06/13/19

Earlier this year, we blogged about CMS updating its WCMSA Reference Guide. Specifically, we pointed out that CMS for the first time included explicit examples in which the settlements would not meet ...
Read More

Issuance of Medicare Part D Conditional Payment Letters Increasing

• 06/06/19

Several of our clients have been experiencing an increase in conditional payment letters from Medicare Part D prescription drug plans. Historically, Part D plans have been less active in recovery of ...
Read More

United States Sues to Recoup Conditional Payments; Asserts that It Does Not Have to Reduce Its Lien for Attorneys’ Fees

• 03/04/19

A new decision by the U.S. District Court for the Middle District of Pennsylvania, entitled United States v. Angino, 2019 U.S. Dist. LEXIS 30499 (February 26, 2019), which involves the United States filing a ...
Read More