This CMS webinar explains Medicare administration, eligibility, covered services, and reimbursement.
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Many people believe Medicare will pay for their long-term care costs. That’s not true. Medicare will pay for UP TO 100 days if you had a qualifying hospital stay, if you are discharged to a nursing home for skilled therapy, and then only while you’re receiving skilled therapy. See Center for Medicare Advocacy, Medicare Skilled […]
The Centers for Medicare and Medicaid Services (CMS) discusses different parts of Medicare.
The Administration for Community Living announced that it will host a Medicare Virtual Fair on Wednesday, June 23, 2021 Open 3:00-7:00 PM ET. Agenda and Registration (available in English and Spanish) This virtual fair is for people turning 65, retiring, or joining Medicare because of a disability. Learn about Medicare and all its parts to help […]
Richard J. Medalie, brought suit under the Medicare Secondary Payer statute (the “MSP”) against the drug companies that developed, manufactured, and marketed the drug Baycol. Following its decision in Stalley v. Catholic Health Initiatives, Nos. 06-3884, 06-4121, 2007 U.S. App. LEXIS 27331, 2007 WL 4165751 (8th Cir. Nov. 27, 2007), the Court held that an MSP […]
In a “short” order, the District Court adopted the Report and Recommendation of the Magistrate finding that a medical malpractice settlement was not subject to any Medicare repayment or lien. It does not appear as though CMS was a party to the action. Thomas G. Golden of Bainbridge Island, Washington, represented the Plaintiff. Mr. Golden […]
Stalley brought a qui tam action against a group of skilled nursing facilities for failing to reimburse Medicare under the Medicare Secondary Payer Act (MSP). The action was removed and then the Defendants filed a motion to dismiss for lack of Article III standing. Because he was neither eligible for Medicare nor injured, the Court […]
Lakeridge is an Ohio nursing home that participates in Medicare and Medicaid. When it was surveyed, it was found out of compliance with several provider requirements. It was fined a civil monetary penalty of $80,300. The fine was upheld and affirmed on appeal. Among the violations cited were “one violation of 42 C.F.R. § 483.25(h)(2), […]
Plaintiff contested Medicare’s claim under the MSP statute. Initially counsel informed Medicaid by letter that there was no duty to reimburse Medicare due to the holding in Thompson v. Goetzmann, 315 F.3d 457 (5th Cir. 2002). Medicare responded that even if Goetzmann was relevant, it would not apply to beneficiaries residing outside the Fifth Circuit. […]
Plaintiff brought a claim under 42 U.S.C. § 1395y(b)(3)(A) to recover funds for the Medicare program attributable to cigarette smoking. The trial court dismissed the claim. On appeal, the court found that “[u]ntil Defendants’ responsibility to pay for a Medicare beneficiary’s expenses has been demonstrated (for example, by a judgment), Defendants’ obligation to reimburse Medicare does […]
