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/

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Settlement Contingent Upon CMS Approval of WCMSA: Problematic?

• 05/08/18

A decision just issued out of the Third Circuit Court of Appeal in Louisiana demonstrates the various nuances and obstacles that may be present when entering into a workers’ compensation settlement ...
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Sixth Circuit Court Gets It Right, and Finally Some Limitations on the Use of the MSP Double Damages Private Cause of Action

• 04/19/18

As I have noted in numerous recent blogs, Medicare Secondary Payer (MSP) Private Cause of Action litigation has been on the rise and has grown to be incredibly rampant in the past several years. Innate to ...
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CMS Finalizes Policy Changes for Medicare Part D Drug Benefits in 2019: Crackdown on Medicare Payment for Opioids Ahead

• 04/03/18

On April 2, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare Advantage Plan (MAP) and Medicare Part D policy changes which provides the plans “with ...
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Fifth Circuit Also Leaning Toward Allowing Medicare Advantage Plans an MSP Double Damages Private Cause of Action Right

• 03/21/18

The U.S. District Court for the Southern District of Texas has issued an opinion in ongoing litigation by Aetna and Humana, both Medicare Advantage Plans (MAPs), against a Plaintiff law firm that represented ...
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Dissenting Judge in Western Heritage Case Issues Opinion Year After Case was Decided – Outlines Reasons Against Medicare Advantage Plans Having the Right to Medicare Secondary Payer Private Cause of Action

• 01/30/18

Recall that in September 2016, the Eleventh Circuit Court of Appeals ruled that Humana Medicare Advantage may sue a primary plan for failure to reimburse conditional payments under the Medicare Secondary ...
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Commercial Repayment Center Transition Webinar: Transition to New Contractor, Performant, to be “Seamless”

• 01/19/18

Yesterday, January 18th, the Centers for Medicare & Medicaid Services (CMS) conducted a webinar for Non-Group Health Plans (NGHPs) to discuss the transition of the new Commercial Repayment Center (CRC) ...
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CMS Maintains Thresholds for Workers’ Compensation, Liability and No-Fault at $750

• 12/01/17

As required by section 202 of The SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts. Last year in 2016, CMS announced that ...
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District Court of New Mexico: “The uncertainty created by CMS's repeated failure to clarify its position on requiring MSAs in personal injury settlements is proving burdensome to the settlement process.”

• 11/29/17

The United States District Court for the District of New Mexico has issued an interesting decision involving the uncertainty for the need of a Liability Medicare Set-Aside (LMSA) in a medical malpractice ...
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CMS Re-Issues Provider Notice Regarding All Types of MSAs- Work Comp, Liability, and No-Fault; Progressive Insurance Settles Medicare Secondary Payer False Claims Act Action for $2 Million Dollars

• 11/20/17

Liability Medicare Set-Asides (LMSAs) and No-Fault MSAs (NFMSAs) Update: I recently issued a blog that CMS withdrew/rescinded a MedLearn article to medical providers which directed medical providers to bill ...
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