Synergy Blog

From Roger Baron: Cert Denied in GSK v. Humana Case Involving Medicare Advantage Plan’s Recovery Rights

Reprinted with Permission from Roger Baron

Today the Supreme Court denied the Petition for Writ of Cert filed in response to the 3rd Circuit’s decision which permits private “Medicare Advantage” insurers to utilize the federal statute [Medicare Secondary Payer Act, 42 U.S.C. 1395y(b)(2)] to pursue a federal cause of action for subrogation.  The 3rd Circuit’s decision is not only problematic for insureds, it also permits subrogation recoveries to be channeled into the pockets of the private insurers, as well as Rawlings and the other subro collection agents.

To view the Petition which was denied click HERE.  Below is the message which Mr. Baron sent out about this case on December 7, 2012.

As most of you are aware, the 3rd Circuit recently decided that private insurers offering Medicare Advantage coverage were permitted to utilize the federal statute [Medicare Secondary Payer Act, 42 U.S.C. 1395y(b)(2)] to pursue a federal cause of action for subrogation.  This decision was a “first of its kind” and, in my opinion, somewhat outrageous because it permits the subrogation recoveries to be channeled into the pockets of the private insurers, as well as Rawlings and the other subro collection agents.

The 3rd Circuit’s ruling is now being challenged in the Supreme Court.  The attached Petition for Writ of Cert was filed two days ago.  The attorneys seeking cert are seeking amicus support.  It is probably too short of notice for any of us to muster up an amicus brief in support of this Petition.  But if, by chance, you know of an organization that would like to do so, that would be great.

TESTIMONIALS

I wanted to pass my highest recommendation to Synergy who we routinely get involved in cases when Medicare issues come up, especially when dealing with Medicare Set Asides. Synergy went beyond the call of duty in a recent case that was settled and dealt one-on-one with our clients and their family. They spent time on the phone with them to be sure they got all their questions answered and did a fantastic job dealing with Medicare.

J. Daniel Clark
Clark Martino, P.A.

"Coincidentally, on the day of a recent Synergy Seminar on Medicare & ERISA lien resolution I received a letter on an ERISA lien. This letter followed much back and forth between myself and the recovery vendor for BCBS. Despite my efforts they were adamant there would be no (zero)(zilch)(nada) reduction and provided case law to support their position. I tried Synergy’s Lien Resolution Services since I had just heard their Director of Lien Resolution speak. Synergy got them to reduce their claim by a third in less than ten (10) days. The result was quick and the fee very reasonable. If you have a tough ERISA lien and your typical efforts don’t work, give Synergy a try."

Michael S. Smith, Esq.
Lesser, Lesser, Landy & Smith, PLLC

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