The Latest Medicare Advantage Decisions: Their Significance and Loopholes, Analyzed
In August 2016, the U.S. Court of Appeals for the Eleventh Circuit issued two opinions in Humana v. Western Heritage, affirming that Humana has a right to be reimbursed the conditional payments it has made, and is entitled to double damages pursuant to the Medicare Secondary Payer Act (MSP) as well as MSP Recovery v. Allstate, holding that a first-party no-fault insurer’s contractual obligation can provide the “demonstrated responsibility” necessary to allow a claim against the insurer for double damages under the MSP. While these decisions are considered as major victories for Medicare Advantage Organizations (MAOs), it is crucial for liability insurers, no-fault carriers and other primary payers to have a clear understanding of the recent ruling and watch out for its loopholes to mitigate potential legal challenges.
In this two-hour LIVE Webcast, a panel of distinguished professionals and thought leaders organized by The Knowledge Group will provide the audience with an in-depth discussion of the latest Medicare Advantage decisions and will help them understand all the important aspects of this significant topic. Speakers will also offer best practices in developing and implementing effective strategies in mitigating common pitfalls and risk issues. Also included will be a discussion of the current regulatory landscape, focused on the ongoing effort to repeal the Affordable Care Act, with its implications for Medicare Advantage and federal regulation of health care as a whole.
Key issues that will be covered in this course are:
- Medicare Secondary Payer Act – An Overview
- Recent MSP Ruling - Humana v. Western Heritage
- Recent MSP Ruling – MSP Recovery v. Allstate
- Significant Implications and Loopholes
- Primary Payer Reimbursement Obligations
- Regulatory and ACA Repeal Forecast
Ryan L. Woody, Partner
Matthiesen, Wickert & Lehrer, S.C.
Humana Med. Plan, Inc. v. W. Heritage Ins. (11th Circuit)
- Private Cause of Action
- “Appropriate Reimbursement”
- Double Damages
- Dissent, Judge Pryor
MSP Recovery v. Allstate (11th Circuit)
- “Demonstrated Responsibility” Litigation
- When is an MSP Suit Ripe?
Humana, Inc. v. Paris Blank LLP, (E.D. Va.)
- Attorney as Defendant under the MSP
What Can We Expect Next?
- Expansion of MSP claims against attorneys.
- Expanding the Private Cause of Action to Anti-subrogation states and the 9th Circuit.
- Exploring an MAO’s “Right to Charge”
- Possible Legislative Reforms
Are There Any Loopholes?
- Challenges to the amount of the MAO lien?
- Are there state law claims procedure defenses that can be raised like in Caldera?
Jennifer A. Creedon, Partner
Martin, Magnuson, McCarthy & Kenney
- MSP Compliance Framework and Medicare A & B Compliance
- How Should Companies, who settle lawsuits, change their compliance programs post Humana v Western Heritage, MSP Recovery v. Allstate and In re Avandia
- How practitioners who settle lawsuits should adapt their discovery and settlement practices post- Humana, MSP Recovery and Avandia
- Risk tolerance in the MSP Compliance Realm
- Would repealing the ACA/SMART Act effect even the settling of lawsuits?
Michael P. Abate, Partner
Dinsmore & Shohl LLP
- The history of the reimbursement dispute
- The district court litigation
- The parties’ arguments on appeal
- The oral argument
- The court’s decision
James A. Washburn, Partner
Troutman Sanders LLP
- Status of Reevaluation of the PPACA
- Means to repeal and replace
- Implications for Medicare Advantage Plans 4. Possible timing for changes 5. Additional Medicare reform alternatives
Who Should Attend:
- Health Care Law Attorneys
- Healthcare Service Providers
- Health Care Organizations
- Health Care Advisers and Counsel
- Health Care Insurance Companies
- Medical Directors
- Other Related/Interested Professionals and Organizations
Ryan Woody is a partner with the law firm of Matthiesen, Wickert & Lehrer in its Wisconsin office. Ryan concentrates his practice on civil litigation with a focus on ERISA and Medicare Advantage. He is nationally recognized for subrogation, reimbursement, and mass tort lien resolution. Ryan has represented clients in high profile Medicare Advantage cases resulting in precedent setting decisions such as Collins v. Wellcare, Humana, Inc. v. Medtronic, and Humana v. Western Heritage. He is a frequent speaker and has contributed to numerous articles and national treatises on ERISA and Medicare Advantage.
Ryan Woody is a partner with the law firm of Matthiesen, Wickert & Lehrer in its Wisconsin office. Ryan concentrates …
Jennifer Creedon is a trial attorney who represents large and small companies in asbestos, product liability and business litigation. Whether a company’s litigation is confined to one lawsuit or requires a multi-lawsuit solution, Jen can craft a defense strategy that fits the company’s needs.
Jen has defended toxic tort and product liability actions in Massachusetts, Rhode Island and Connecticut. She has served as local, regional and national counsel for companies regarding toxic tort/asbestos litigation. Jen has been part of a national counsel team for a Fortune 500 company, drafted nationwide discovery, designed national trial strategy, including preparation of corporate/expert witnesses.
Additionally, Jen has handled Federal Multidistrict Litigation, including cases consolidated in MDL 875 and the Maritime Docket. She can also coordinate a company’s compliance with the Medicare, Medicaid and SCHIP Extension Act of 2007.
Jennifer Creedon is a trial attorney who represents large and small companies in asbestos, product liability and business litigation. Whether …
Michael Abate is a Partner at Dinsmore & Shohl LLP. He chairs the Firm’s Appellate Practice Group and also is a member of the Firm’s Litigation and Health Care departments. Mike has extensive experience litigating at all levels of the federal court system. He regularly represents Medicare and Medicaid Managed Care Organizations in litigation and regulatory matters, including in disputes arising under the Medicare Secondary Payer Act. He also handles internal investigations and False Claims Act matters for MCOs and medical providers. Prior to joining Dinsmore, Michael worked in the Civil Division of the U.S. Department of Justice, where he maintained a nation-wide appellate and trial practice handling the United States’ most sensitive litigation matters, including a wide variety of constitutional, statutory, and regulatory disputes. Michael previously served as a law clerk to the Honorable Diana Gribbon Motz on the U.S. Court of Appeals for the Fourth Circuit in Baltimore, MD. He is a graduate of Stanford Law School and Harvard College.
Michael Abate is a Partner at Dinsmore & Shohl LLP. He chairs the Firm’s Appellate Practice Group and also is …
James Washburn is a partner in the Atlanta office of Troutman Sanders LLP, a 650-lawyer national law firm. James is a commercial litigator with extensive experience handling a variety of disputes for both health care providers and payors, both earning significant verdicts and defending claims in court, on appeal, and in arbitration. James also has represented clients in successfully challenging health care and insurance regulations before administrative agencies and in state and federal courts. In addition, James has represented both public officials and business interests in a variety of disputes with local, state, and federal government entities, including government contracts, bid protests, tax disputes, ethical compliance, and other matters.
James Washburn is a partner in the Atlanta office of Troutman Sanders LLP, a 650-lawyer national law firm. James is …
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NASBA Field of Study:
Business Law - Technical
NY Category of CLE Credit:
Areas of Professional Practice
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About Matthiesen, Wickert & Lehrer, S.C.
Matthiesen, Wickert & Lehrer, S.C. is a national litigation law firm, handling all lines of subrogation, including workers’ compensation, property and casualty, auto, health, disability, product liability, construction defect, and cargo claims. Our National Subrogation Recovery Program has served the subrogation needs of over 250 insurance carriers, TPAs, and self-insured entities resulting in over $1 billion in recoveries and credits since 1983. Our website contains a plethora of free subrogation resource tools, charts, articles, and webinars to assist the subrogation professional. In addition, we specialize in defending health insurers and self-insured employers nationwide involving medical provider billing disputes, as well as denial of benefit and bad faith claims.
About Martin, Magnuson, McCarthy & Kenney
Since 1957, Martin, Magnuson, McCarthy & Kenney has been committed to protecting our clients and providing exceptional representation. Our attorneys possess extensive litigation and appellate experience and have significantly impacted the development of tort law in Massachusetts. In the last five years, we have obtained over 100 jury verdicts in favor of our clients in high exposure cases involving death, serious brain damage and catastrophic personal injuries. We have represented clients on appeal before the Supreme Judicial Court of Massachusetts, Massachusetts Court of Appeals and First Circuit Court of Appeals.
Due to the depth of our experience, members of our firm have been requested to serve as arbitrator or mediator by private litigants to assist in alternative dispute resolution. Our experience and commitment to quality legal representation and proven results distinguish MMM&K.
About Dinsmore & Shohl LLP
Dinsmore & Shohl is a full service law firm with over 650 attorneys in 21 cities across the United States.
About Troutman Sanders LLP
Founded in 1897, Troutman Sanders LLP is an international law firm with more than 650 lawyers practicing in 16 offices located throughout the United States and Asia. The firm’s clients range from large multinational corporations to individual entrepreneurs and reflect virtually every sector and industry. The firm’s heritage of extensive experience, exceptional responsiveness and an unwavering commitment to service has resulted in strong, long-standing relationships with clients across the globe. In recognition of the firm’s strong service culture, Troutman Sanders has been on the BTI Client Service A-Team for 13 consecutive years.