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Practice Tip: Medicare Secondary Payer Reporting Requirements Complicate Settlement
Since 1980, Medicare has been entitled to recoup funds it has paid conditionally to cover Medicare recipients' health care, where those recipients make claims that are subsequently settled or result in a damage award at trial. 42 U.S.C. ' 1395y(b). Because this statutory entitlement has been largely “honored in the breach,” in 2007 Congress enacted new reporting requirements for entities primarily responsible for the health care costs of injured parties, and imposed hefty civil fines for those who fail to report. 42 U.S.C. ' 1395y(b)(7), (b)(8) (the “Medicare, Medicaid and SCHIP Extension Act of 2007″ or “MMSEA”). This reporting requirement has generated a detailed and cumbersome set of regulations, rules and new requirements for designated Responsible Reporting Entities (“RREs”).
This article explores some of the practical impacts of the
MMSEA on settlement of product liability cases. It does not address the reimbursement process vis-'-vis judgments or claims involving ongoing or future medical treatment, although some of the same principles and procedures apply. The processes described below continue to evolve, as do Medicare's procedures and communications. As a result, and because of its brevity, this outline is necessarily incomplete. Fortunately, guides to handling MMSEA's requirements have been prepared by various bar organizations. A users' manual and computer-based training programs also are available from one of Medicare's Coordination of Benefits Contractors (“COBC”), the Centers for Medicare & Medicaid Services (“CMS”) at www.cms.gov.
The DOJ's Corporate Enforcement Policy: One Year Later
The DOJ's Criminal Division issued three declinations since the issuance of the revised CEP a year ago. Review of these cases gives insight into DOJ's implementation of the new policy in practice.
The DOJ's New Parameters for Evaluating Corporate Compliance Programs
The parameters set forth in the DOJ's memorandum have implications not only for the government's evaluation of compliance programs in the context of criminal charging decisions, but also for how defense counsel structure their conference-room advocacy seeking declinations or lesser sanctions in both criminal and civil investigations.
Use of Deferred Prosecution Agreements In White Collar Investigations
This article discusses the practical and policy reasons for the use of DPAs and NPAs in white-collar criminal investigations, and considers the NDAA's new reporting provision and its relationship with other efforts to enhance transparency in DOJ decision-making.
Bankruptcy Sales: Finding a Diamond In the Rough
There is no efficient market for the sale of bankruptcy assets. Inefficient markets yield a transactional drag, potentially dampening the ability of debtors and trustees to maximize value for creditors. This article identifies ways in which investors may more easily discover bankruptcy asset sales.
A Lawyer's System for Active Reading
Active reading comprises many daily tasks lawyers engage in, including highlighting, annotating, note taking, comparing and searching texts. It demands more than flipping or turning pages.