Conditional Payments / Lien Resolution
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Medicare Advantage Plan’s Conditional Payments Limited by New York Laws
by P. Czuprynski In Claims v. Merchs. Mut. Ins. Co.[1], the Court partially denied Medicare Advantage Plan’s suit over conditional payment reimbursements and highlights a possible defense for carrier/self-insureds to...
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FL Court of Appeal Reverses Class Certification by MSP Recovery for a Third Time
by M. Heberling We have previously written about the challenges MSP Recovery and their subsidiaries have experienced when trying to effectively navigate state procedural requirements and properly establish a claim...
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Settlement Enforced Despite Dispute on Medicare and Medical Lien Terms
by P. Czuprynski In Smith v. Wal-Mart Stores E., LP.[1], a claimant filed a complaint alleging that Wal-Mart and Vestis Services was negligent, resulting in a slip and fall. The...
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CMS Implements Medicare Set-Aside Data Sharing for Part D Plans
by P. Czuprynski The Centers for Medicare & Medicaid Services (CMS) recently announced that beginning in February 2026, they will share data elements, including specific prescription drug information, with Part...
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A Cautionary Tale: Cabezas v. Penske Truck Leasing Co.
by B. Smith When it comes to disputes regarding the resolution of conditional liens as part of settlement, the courts will usually defer to settlement terms as their guide. This...
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Magistrate Denies Conditional Payment Reimbursement Request by MAP Plan
by P. Czuprynski In Series v. State Farm Mut. Auto. Ins. Co., 1:23 CV 22982 (July 15, 2025), the Magistrate Judge agreed that Series’ suit for conditional payment reimbursement should...
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Is Medicare Denying Payment for Treatment Under the MSP Act for Workers’ Compensation and Liability Claims?
by P. Czuprynski The Medicare Secondary Payer (MSP) Act allows Medicare to make payment and then seek reimbursement for Conditional Payments. This occurs when Medicare asks for reimbursement associated with...
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IIGF is Not a Primary Payer Under the Medicare Secondary Payer Act
by P. Czuprynski In IIGF v. Becerra[1] the United States District court for the Northern District of Illinois determined conditional payments alleged by Medicare, did not require reimbursement by IIGF...
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Administrative Procedure Act: Medicare, Medicare Advantage and Prescription Plans Must Follow its Regulations
With Chevron Deference being overturned, stakeholders facing conditional payment demands or payment denials by Medicare have a better chance of success in challenging Medicare’s decision. Federal district court review of...