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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CMS Alert: New Contractor for NGHP Recoveries and Benefits Coordination in ORM

• 07/01/15

Today, July 1, 2015, CMS issued an alert which states that come October 2015, the Benefits Coordination and Recovery Contractor will be transitioning some of its recovery caseload to a new contractor which ...
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Collateral Source Rule Does Not Apply to Medicare Payments

• 06/24/15

In an opinion out of Delaware, Stayton v. Delaware Health Corporation, et.al, 2015 WL 3654325 (June 12, 2015), Delaware's Supreme Court found that the collateral source rule does not apply to payments ...
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Workers’ Compensation Medicare Set-Aside Reform Introduced in Congress

• 06/08/15

On June 4, 2015, workers' compensation Medicare Set-Aside (WCMSA) legislation was introduced in both the House and Senate. In identical bills, the House, the bill (HR 4269) was introduced by ...
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Recent CMS Query Issue with Partial SSNs

• 06/02/15

In November 2014, pursuant to the SMART Act, CMS implemented a process where Responsible Reporting Entities (RREs) could use a partial SSN (last 5 digits) where the RRE was unable to obtain the ...
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State Appellate Court Reinstates Plaintiff’s MSP Private Cause of Action Against No-Fault Insurer– “Demonstrated Responsibility” can be Established Without a Settlement, Judgment, or Award based on Insurance Contract

• 05/22/15

I recently posted a blogwire article regarding CMS' May 5th webinar wherein CMS expressed their intent to recover conditional payments in Ongoing Responsibility for Medical (ORM) cases. This ...
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California WC Statute Helpful to Reduce WCMSA Allocations

• 05/15/15

SB 863 launched Independent Medical Review (IMR) for California Workers' Compensation claims.  This important shift in how medical treatment is managed in a workers' compensation claim would ...
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CMS Hosts Webinar on Applicable Plan Appeals; Announces Plans to Collect Conditional Payments in ORM Situations

• 05/06/15

Yesterday, CMS held a webinar on the applicable plans newly created right of appeal that went into effect on April 28, 2015. Because of the Strengthening and Repaying Taxpayers (SMART) Act, CMS was required ...
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Pennsylvania District Court Case Demonstrates the Importance of Addressing Medicare Secondary Payer Issues Early in Settlement Process

• 04/26/15

In an opinion out of the United States District Court for the Eastern District of Pennsylvania, Villare v. GEICO Casualty Company, 2015 U.S. Dist. LEXIS 36488, what would have been a finalized settlement ...
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MSP Private Cause of Action: Litigants and Recovery Programs Pushing the Envelope in the Hopes of Recovering Double Damages

• 04/20/15

The Medicare Secondary Payer (MSP) Private Cause of Action (PCOA) provides for double damages when a primary plan fails to pay for Medicare's conditional payment.  See 42 USC ...
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