 In CMS’ efforts to improve the quality of care, as of October 1, 2008 Medicare will not pay for certain injuries/conditions acquired during inpatient care, these injuries/conditions have been named by CMS as “never events” or “hospital acquired conditions” (HACs). CMS has advised state Medicaid Agencies to amend their statutory language to ensure that payment is not made through Medicaid for those beneficiaries that may have dual eligibility.  Read the rest of this entry »
Archive for May, 2010
Malpractice- Medicare will not pay for “Hospital Acquired Conditions a.k.a “Never Events”
Wednesday, May 19th, 2010Medicare Secondary Payer Reform… Could it be?
Wednesday, May 19th, 2010On October 2, 2006 CMS consolidated all conditional payment recovery functions. CMS transitioned from several recovery contractors nationwide to a single contractor in Chickasaw Nations Industry, LLC. (CNI). This branch of CNI is the “Medicare Secondary Payer Recovery Contractor” (MSPRC). Since 2006 the recovery process has improved, but the frustrations involved with resolving Medicare conditional payments still linger. BUT, could change be coming soon? A Federal Court Judge has granted action to proceed in a potential class action suit. The suit will challenge the MSPRC’s recovery procedures.
As explained by Jon L. Gelman:
“The case pending in Arizona questions the authority of the HHS to seek reimbursement in liability claims of conditional payments paid by the Federal government. The plaintiffs are seeking declaratory and injective relief from the HHS procedures. They allege that the HHS has exceeded its authority under the MSP and that the plaintiffs have been denied due process. Read the rest of this entry »
Ask A Lien Professional – Wrongful Death and Medicare
Wednesday, May 5th, 2010Question:Â
“I am the executor of estate on behalf of my mother who was a Medicare beneficiary. This is a wrongful death case, so does Medicare have a lien in this situation?“ – Florida Resident
Answer:
According to the Medicare Secondary Payer Manual (Chapter 50.5.4.1.1), Medicare’s right to recover against a wrongful death claim depends on two things, 1. The beneficiary’s state of residence, and if the state law allows for the recovery of medical expenses in a wrongful death claim, and 2. If the state’s law allows for recovery of medical claims, the amount Medicare is entitled to recover against may vary (full recovery in some states, limited recovery in others). So basically, depending on where the beneficiary lived, there may or may not be an obligation to Medicare. Some states do not allow for the recovery of medical payments, so in those states Medicare cannot assert a claim against the deceased beneficiary or survivors. Read the rest of this entry »
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