Medicare Secondary Payer Act: New CMS Rules and Case Law for Liability and No Fault Settlements


CLE credits earned: 2 GENERAL (or 2 LAW & LEGAL for WA state)

The Medicare Secondary Payer act (MSP) was enacted on December 5, 1980. Despite being federal law for over thirty-five years, many attorneys still struggle with ensuring their settlements fully comply with the statute’s three basic requirements: ensure Medicare remains secondary to settlement proceeds, reimbursement of Medicare’s conditional payment amount, and report the settlement via the Section 111 reporting requirement.

Since 2009, the Centers for Medicare and Medicaid Services (CMS) has methodically stepped up its enforcement of the MSP statute in all liability settlements. The most recent changes to CMS enforcement came in Fall 2017 when CMS took steps to ensure Medicare does not make any accident-related medical payments post-settlement.

This course is co-sponsored with myLawCLE.

Key topics to be discussed:

•   When is your settlement primary to Medicare?
•   2017 changes to the Common Working File and Educational Outreach to Medical Providers
•   The impact of Aetna vs Guerrera on Medicare Part C lien searches
•   This CLE will include a detailed discussion of new policy/procedures anticipated by CMS in late 2019/early 2020

Date / Time: November 19, 2020

•   2:00 pm – 4:00 pm Eastern
•   1:00 pm – 3:00 pm Central
•   12:00 pm – 2:00 pm Mountain
•   11:00 am – 1:00 pm Pacific

Choose a format:

•   Live Video Broadcast/Re-Broadcast: Watch Program “live” in real-time, must sign-in and watch program on date and time set above. May ask questions during presentation via chat box. Qualifies for “live” CLE credit.
•   On-Demand Video: Access CLE 24/7 via on-demand library and watch program anytime. Qualifies for self-study CLE credit. On-demand versions are made available 7 business days after the original recording date and are view-able for up to one year.

Select your state to see if this class is approved for CLE credit.

Choose the format you want.


Original Broadcast Date: January 13, 2020

Christine Hummel, Esq. is the President and founder of Hummel Consultation Services, a legal consultation practice specializing in the application of the Medicare Secondary Payer Act. An active attorney with licensure in the state of Colorado, she earned her Juris Doctor from the University of Denver in May 2000. In 2002 Christine opened her own firm, which recently celebrated its seventeenth continuous year of operation. With twenty years of experience, Christine is a published author and popular speaker on a wide array of topics related to Medicare compliance. Christine has significant experience working with the Centers for Medicare and Medicaid Services in regarding applicability of the Medicare Secondary Payer Act to liability settlements. She is a member of the American Bar Association, the Colorado Bar Association, and includes with her legal experience work in Medicaid, probate, and elder law. Christine volunteers her free time by giving presentations on the roles of women throughout multiple time periods in history.

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Section I: Overview of the Medicare Program and Medicare Secondary Payer Act
a) What is Medicare
b) Qualifying for Medicare
c) Three basic statutory requirements of the Medicare Secondary Payer Act

Section II: Section 111 Reporting
a) Who reports?
b) When do you report?
c) What do your report?
d) Penalty for failing to report: Notice of Proposed Rule Making anticipated by October 2019

Section III: Medicare’s Conditional Payment
a) Traditional Medicare: Parts A and B
        i. Difference between the Benefits Coordination Recovery Contractor and the Commercial Repayment Center
        ii. Compromise Requests
        iii. Waiver Requests
        iv. The Final CP Process
b) Medicare Part C and D plans
        i. Statutory authority for Part C and Part D plans to assert a lien
        ii. Key differences between Medicare A/B liens and Medicare C/D liens
        iii. Case law discussion: In re Avandia, Humana cases, and Aetna vs Guerrera
c) Pitfalls and traps when conducting the Medicare conditional payment search(es)
d) Practice Tips

Section IV: The Medicare Set Aside (future medical allocation)
a) Statutory Authority for CMS’ position that your settlement is primary to Medicare
b) Case Law Discussion including the Aranki case and the Duff case
c) What medical treatment should be paid from settlement proceeds
d) Strategies for reducing the Set Aside allocation
e) October 2017 changes to the Common Working File
f) November 2017 educational outreach by CMS to the Medical Community and its impact on your clients
g) Notice of Proposed Rule Making anticipated by October 2019
h) Practice Tips