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Ghostbusters

In 1984, Ivy League trained parapsychologists Venkman, Stantz, and Spengler started a ghost-catching business in New York City, despite implausible research, and eventually were welcomed as heroes by saving the city from the paranormal disguised as giant marshmallow man Stay Puft.  Only in the movies!  But, we can use this ghoulish time of the year to serve as a reminder:  Don’t let MSP enforcement claims by Medicare Part C Advantage Plans sneak up to shock and detract your standard claims operating procedures.  Identifying and resolving these repayment claims may be just as important a part to your overall MSP compliance strategy as similar claims by traditional Medicare Parts A and B.

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How far is too far when negotiating Medicare release terms?

At the recent NAMSAP Educational Conference in Baltimore, during a breakout panel discussion on “Leveraging Settlement with Medicare Set-Asides in Mediation”, a rather strident concern was raised with respect to the reasonable scope of terms in a settlement release irrespective of the type of primary plan covering the loss.  Specifically, attendees questioned whether Medicare eligible individuals could or to what extent may release their claim or claims in the future to these public health and welfare insurance benefits while negotiating compromise settlement provisions under liability, no-fault or workers compensation plan.

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Treasury Trove

Medicare is paid for through two Trust Fund accounts—Hospital Insurance and Supplementary Medical Insurance—held by the United States Department of Treasury, How Is Medicare Funded. In 2018, over 60 million people were covered by Medicare with over $731 billion in total expenditures from the Trust Funds Facts on Medicare Spending and Financing.  Further, CMS reports validating $493.68 million in recoverable mistaken conditional payments, while returning $98.68 million dollars to the Medicare Trust Funds in 2018 as a direct result of its recovery program activities, on top of $131.78 million in 2017, MSPRC Commercial Repayment Center in Fiscal Year 2018. Collection activity by the United States Department of Treasury (DOT) on Medicare conditional payments is reportedly increasing in 2019, plus, over the past 15 months, the United States Department of Justice reached six-figure settlements with two Plaintiff’s law firms for failure to repay Medicare conditional payments.

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Top 10 MSP Compliance Waypoints in 2019

Key moments, thus far, to review and consider on the 2019 Medicare Secondary Payer voyage. Medicare Secondary Payer compliance can be complex with many changes to track from different and connected sources which affect administrative policies, procedures and processes.  Flagship’s educational solutions are thoughtfully designed to explain matters in simple terms which help your team be informed and equipped to seriously chart an easier and safer compliance course.

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Flagship Welcomes Robert J. Finley as Chief Legal Consultant

August 5, 2019

Valued Flagship Clients,

Flagship Services Group, is pleased to announce that Robert J. Finley will serve as our Chief Legal Consultant. We are excited to work with Mr. Finley, who brings both knowledge and practical experience in Medicare Secondary Payer (MSP) compliance and regulation, as well as Medicaid third party liability and reimbursement matters.

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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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Commercial Repayment Center Returned $131.78 Million to Medicare Trust Fund in FY 2017

Rafael Gonzalez, Esq. President, Flagship Services Group

As Required by Section 1893(h) of the Social Security Act, the United States Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Medicare Secondary Payer (MSP) Commercial Repayment Center (CRC) published its third annual report to Congress for FY 2017 in March 2018. https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Downloads/The-Medicare-Secondary-Payer-Commercial-Repayment-Center-in-Fiscal-Year-2017.pdf. Based on the Group Health Plan (GHP) and Non-Group Health Plan (NGHP) recovery work of the CRC, for FY 2017 (October 1, 2016 through September 30, 2017), CMS returned $131.78 million dollars to the Medicare Trust Funds.

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New Work Comp MSA Review Contractor Starts 3/19/18; No Expected Changes and No News on Liability MSAs

Rafael Gonzalez, Esq. President, Flagship Services Group

It has been a long time coming, two years to be exact. After the Centers for Medicare and Medicaid Services (CMS) announced their anticipated release of a solicitation for the Workers’ Compensation Review Contractor (WCRC) in 2016 and 2017 and further announced it was continuing to consider expanding its voluntary MSA review process to include liability insurance (including self-insurance) and no-fault insurance MSA amounts in 2016 and 2017, Medicare Secondary Payer (MSP) stakeholders never thought the day would come. But, after a challenge of the awarded contract and after several months during which Provider Resources continued to work under an expired contract, on March 7, 2018, CMS finally held the WCRC Transition Webinar to introduce Capitol Bridge, LLC, the new workers’ compensation review contractor.

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How Flagship Services Group Helps Claims Adjusters – Part Two

This is the second in a two-part blog series involving the day-to-day role of a claims adjuster at the average P&C insurance carrier and how Flagship Services Group can make that day easier and more rewarding.  In the last post, we looked at some potential pitfalls the average claims adjuster does not want to deal with.  In this post, we’ll discuss how these pitfalls are avoided.

As we noted in the previous post, the average claims adjuster at a mid-size to large P&C insurance carrier has a heavy case load and a lot of stringent requirements and KPIs keeping them on their toes. 

We were introduced to Bob, a P&C staff claims adjuster who just opened up a new file to find it’s one of those dreaded Medicare reimbursement cases.  The claimant is a Medicare beneficiary who was injured in a motor vehicle accident and was in the hospital for several days.  In addition, he has ongoing physical therapy and follow-up medical bills in the mix.  Medicare has already paid for the hospitalization and a Conditional Payment Letter is on its way.

Now, Bob only sees one or two of these types of claims every month, in among as many as 200 claims he may touch in that same amount of time.  As a result, he’s not completely comfortable with all the regulations involved, and he knows it’s going to take a lot of time to research it and get that all straight before he can proceed with confidence.  

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