Progressive Insurance Company Settles Medicare and Medicaid Secondary Payer False Claims Act for $2.4 Million

Posted by Rafael Gonzalez on Nov 22, 2017 9:12:10 AM

Auto, liability, no-fault, and work comp primary payers- if you didn’t take Medicare and Medicaid secondary payer issues seriously before, here are over 2 million reasons why you should.

On November 14, 2017, the United States of America, the State of New Jersey, Progressive Garden State Insurance Company, Progressive Casualty Insurance Company, and Relator Elizabeth Negron entered into a settlement agreement for $2,392,700 on a False Claims Act matter in which certain Progressive automobile insurance policies caused health care providers to submit medical claims to Medicare and Medicaid in violation of secondary payer laws.

Read More

Topics: medicare, medicaid

Resolution of Conditional Payments Continue to Create Havoc on No-Fault Claims

Posted by Rafael Gonzalez on Aug 20, 2017 8:00:00 AM

Medicare conditional payments are serious business. They continue to challenge claims professionals throughout the country. And if not dealt with timely and appropriately, can create havoc on parties’ attempt to settle a claim, or future reimbursement responsibility.

Read More

Topics: Conditional Payments, medicare

Medicare Compliance Case Study

Posted by Rafael Gonzalez on Apr 22, 2016 10:30:00 AM

Introduction & Background

Medicare compliance is a major undertaking, requiring experience, expertise and resources. It should begin at the front end of a claim notice by identifying every claim that has a Medicare-eligible claimant. It does not officially end until a Claim Closure Letter has been obtained from Medicare. The entire process is complicated because the regulations frequently change, the rebuttal process is time consuming and the response time from Medicare can be lengthy. But when compliance with Medicare regulations is not addressed, or is not done properly, the aggregate exposure for a P&C insurer can easily and rapidly exceed several million dollars.

Read More

Topics: medicare compliance, medicare