News & Analysis as of

Medicare Insurance Claims

Goldberg Segalla

[Webinar] Medicare Tune Up: Boosting Efficiency and Minimizing Costs - August 8th, 12:00 pm - 1:00 pm EDT

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As Medicare secondary payer penalties take effect this fall, find out what’s new, what’s on the horizon, and what to watch out for to avoid pitfalls. Join Goldberg Segalla partners Philip Unwin and Jennifer Santoro for a free...more

Patrick Malone & Associates P.C. | DC Injury...

Better Health Care Newsletter - March 2024

Is Medicare Advantage really a Disadvantage for seniors and taxpayers? Our nation is graying rapidly. Every day, 10,000 baby boomers, members of one of the largest generations in U.S. history, hit the traditional...more

McDermott Will & Emery

Hospitals: Check Your Addresses or Face Medicare Claims Returns!

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Following an implementation delay during the COVID-19 public health emergency (PHE), on August 1, 2023, the Centers for Medicare and Medicaid Services (CMS) initiated Medicare hospital claims edits that will return certain...more

Carlton Fields

7th Cir. Holds Insurance Coverage Applies to Settlement Payments for Alleged Anti-Kickback and False Claims Act Violations

Carlton Fields on

On May 3, 2023, the Seventh Circuit Court of Appeals, in Astellas US Holding Inc. v. Federal Insurance Co., held that a liability insurer was required to contribute its limits toward its insured’s payment to settle potential...more

Rivkin Radler LLP

Insurance Update - May 2023

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Additional insured disputes can sometimes get complicated. How much coverage the additional insured gets is often a hotly contested issue, especially when the named insured has coverage above the minimum limits it promised...more

Goldberg Segalla

[Webinar] Medicare Secondary Payer Compliance Update 2023 - March 22nd, 12:00 pm - 1:00 pm EDT

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Whether it's reporting to CMS, getting CMS approval, or wondering how to handle LMSAs, this webinar will help answer those questions....more

Butler Weihmuller Katz Craig LLP

Dial v. Calusa Palms Master Association, Inc. - Florida Supreme Court Confirms Only Amounts Actually Paid By Medicare Are...

On April 28, 2022, the Florida Supreme Court issued its decision in Dial v. Calusa Palms Master Association, Inc., which addressed the question: DOES THE HOLDING IN JOERG V. STATE FARM MUTUAL AUTOMOBILE INSURANCE CO., 176...more

Polsinelli

HHS Waives Medicare Claim Appeal Deadlines Under Section 1135

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On March 15, 2020, Alex Azar, Secretary of the Department of Health and Human Services (“HHS”) issued Waiver or Modification of Requirements Under Section 1135 of the Social Security Act, available. ...more

K&L Gates LLP

K&L Gates Triage: Activation of Validation Edits for OPPS Providers with Multiple Service Locations

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The Centers for Medicare and Medicaid Services (CMS), recently announced that it plans to activate systematic validation edits for Outpatient Prospective Payment System (OPPS) providers with multiple service locations that...more

Bricker Graydon LLP

Hospitals with off-campus provider-based departments: Check your PECOS enrollment file

Bricker Graydon LLP on

Now is the time to double and triple check your Medicare Provider Enrollment, Chain, and Ownership System (PECOS) enrollment file to make sure all information for off-campus provider-based service locations is correct. ...more

Carlton Fields

Court Finds No Coverage for $42 Million False Claims Act Suit Due To Late Reporting

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A federal court has found no coverage for a $42 million whistleblower settlement due to the insured’s failure to timely report the claim to its carrier. PAMC, Ltd. v. National Union Fire Insurance Company of Pittsburgh, Pa.,...more

Butler Weihmuller Katz Craig LLP

Florida's SIU Tool Belt Is a Bit Lighter Today

Florida has been plagued with insurance fraud for decades.  All insurance coverages are susceptible to fraud, but scams are especially prevalent in the context of automobile accidents.  Staged crashes, patient brokering,...more

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