Sunday, June 1, 2014

Medicare advantage plan does not have the same super lien | Paulding county attorney

The Medicare advantage organizations are insurance companies that contract with Medicare to provide Medicare benefits pursuant to part C of the medical care law, 42 U.S.C. 130 9W-20 1A1. Although the Medicare secondary payer act law applies to Medicare advantage plans a recent Federal District Court decision in Pennsylvania held, as many have argued, that Medicare advantage plan being purely insurance agreements affording benefits equivalent to Medicare did not fall within the statute and regulations governing the Medicare liens. Humana v. Glaxo SmithKline 2011 US Dist. Lexis 63544 (E.D. Pa. June 13, 2011). Instead the District Court held, any right of recovery by MAO depends on the language in the insurance policy and applicable state law. Under this analysis, under Georgia law a Medicare advantage plan would occupy no greater status than an ordinary group plan i.e. is not permitted to subrogate against primary payer's, and the right of reimbursement from a beneficiary under the plan is subject to the made whole doctrine and the other provisions of OCGA 33-24-56.1. Although the Humana case involved a great deal of money, and it is a very well reasoned opinion, it does not appear to be a reported decision. Thus, under local rules of the Northern District of Georgia, its value as precedent is subject to question. Nevertheless, there is a great deal written about this decision, though the case itself is not appealed. Generally, plaintiff lawyers appeared to be responding to notices for Medicare advantage plan by taking the position that it is not entitled to the traditional Medicare lien, and will be treated like a health insurer seeking reimbursement pursuant to Georgia law. There is no reason to think that claims of lien pursuant to Medicare part D affording prescription benefits should be treated any differently than a Medicare advantage  plan, since Medicare part D similarly underwritten by insurers that contract with the government.Contact a Paulding county lawyer today for help with your case.