Is Uniformity on Its Way for Medicare Advantage Plans (MAP) Seeking Medicare Secondary Payer (MSP) R

As we have previously written, primary plans have been the subject of lawsuits by Medicare Advantage Plans (MAPs), Part D providers and Medicaid seeking double damages for the reimbursement of conditional payments. Several courts of appeal have addressed this issue regarding standing to bring such an action with a division among the circuits. So far, the U.S. Supreme Court has not ruled on this issue. However, help may be on the way.

Congressman Gus Bilirakis (R-FL) and Congressman Ron Kind (D-WI) introduced bipartisan legislation to combat this problem on May 18, 2018. The Provide Accurate Information Directly Act (PAID) (H.R. 5881) seeks to close any gaps in the system regarding these issues and more. The Centers for Medicare and Medicaid Services (CMS) has information regarding MAP, Part D or Medicaid enrollment and provides it to Group Health Plans. The PAID Act would compel CMS to also provide this information to Non-Group Health Plans (NGHPs) in order for primary plans to obtain this information and promptly reimburse conditional payments, before a lawsuit is filed seeking double damages.

The information sharing under the PAID Act will streamline the process of obtaining enrollment information and resolving conditional payments. Ultimately, the PAID Act may provide Medicare beneficiaries who are parties to third-party settlements involving workers compensation, auto liability or a tort case, improved access to care.

At Care Bridge, we provide clients with up to date information that impacts Medicare compliance and we streamline the Medicare Secondary Payer process saving you time and money. We are leaders from the insurance industry, with a depth of understanding regarding the coordination of benefits and Conditional Payment recovery process. We will monitor the progress of this bill through the House of Representatives and keep you informed.

At Fidelity Fiduciary, Medicare beneficiaries trust in our expertise, post claim settlement, to deliver high quality access to care and responsible account administration to protect lifetime Medicare benefits.

Deborah Watkins

Chief Executive Officer

Care Bridge International, Inc.

Bennett L. Pugh, JD

Chief Executive Officer

Fidelity Fiduciary Company, LLC

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