Medicare Parts
These two parts together are often referred to as "traditional Medicare"
What are Parts A and B?
In 1965, the government enacted the Social Security Act, which created this government-sponsored health insurance.
What is Medicare?
Using the private cause of action mechanism, a Medicare Advantage Plan can recover conditional payments from this party.
What is a primary payor (and not beneficiaries, their attorneys, or other non-primary payers)? See Meador v. United States, No. 22-cv-40024-DJC, 2024 U.S. Dist. Lexis 24796 (D.Mass. Feb. 13, 2024)
Enacted in 1997, this part creates an alternative to traditional Medicare by involving private contractors
What is Part C?
The two key functions of the MSP Act
What are shifting fiscal responsibility for otherwise-covered services to a primary plan and creating an obligation that prevents Medicare from payment responsibility for future care when primary funds are available?
The number of digits of their social security number a claimant must provide to cooperate with a primary payer's Section 111 reporting requirements
What is 5?
Although Part C was originally referred to as "Medicare + Choice," today it is known as this
What is Medicare Advantage?
These parties all have liability when it comes to ensuring that conditional payments are repaid to Medicare when a primary plan makes payment.
Who are the Plaintiff/Claimant, the Plaintiff's attorney, and the Primary Plan/Insurer?
Protecting Medicare's future interests, if any, following a personal injury settlement is the responsibility of these parties.
Who is the claimant and the claimant's attorney
This section provides voluntary drug benefits to members
What is Part D?
CMS can recover this if it has to sue to recover an unpaid conditional payment
What are double damages?
An acceptable date on a Final Conditional Payment Summary provided by Plaintiff's counsel is this.
What is as recent as possible?
To date, the number of responsible reporting entities that have been fined the $1,000/day penalty for non-compliance with Section 111 reporting
What is none?
Medicare can take this long to collect reimbursement for overpayments.
Generally 6 years (See 28 U.S.C 2415) but also forever (read that with heavy sarcasm)