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Progressive Insurance Company Settles Medicare and Medicaid Secondary Payer False Claims Act for $2.4 Million

Auto, liability, no-fault, and work comp primary payers- if you didn’t take Medicare and Medicaid secondary payer issues seriously before, here are over 2 million reasons why you should.

On November 14, 2017, the United States of America, the State of New Jersey, Progressive Garden State Insurance Company, Progressive Casualty Insurance Company, and Relator Elizabeth Negron entered into a settlement agreement for $2,392,700 on a False Claims Act matter in which certain Progressive automobile insurance policies caused health care providers to submit medical claims to Medicare and Medicaid in violation of secondary payer laws.

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2019 Thresholds

The SMART Act requires the Centers for Medicare & Medicaid Services (CMS) to review its costs related to recovering conditional payments compared to recovery amounts annually.

After their analysis, CMS announced the reporting thresholds for Liability, No-Fault and Workers Compensation claims for 2019.

CMS calculated a threshold for physical trauma-based liability insurance settlements. “Effective January 1, 2019, CMS will maintain a single threshold for these cases, where settlements of $750 or less do not need to be reported and Medicare’s conditional payment amount related to these cases did not need to be repaid.” CMS will also maintain the current $750 threshold for workers’ compensation settlements.

The threshold will remain at $750 for no-fault settlements where the no-fault insurer does not otherwise have ongoing responsibility for medicals (ORM.) “Accordingly, settlements of $750 or less for no-fault insurance and workers’ compensation will not need to be reported and Medicare’s conditional payment amount related to these cases will not need to be repaid.”

The CMS alert can be read here – here
If you have questions about Mandatory Insurer Reporting, Medicare Secondary Payer requirements, thresholds, or Conditional Payment Resolution, feel free to contact Flagship Services Group.