The following summaries are of recent published decisions of the California appellate courts, the Ninth Circuit, and the United States Supreme Court. The summaries are presented without regard to whether Severson & Werson represented a party in the case.
Medicare Subpart C's express preemption provision supersedes any state law or regulation applicable to Subpart C medical plans. The provisions is intentionally broad in scope and was amended to apply to any state law or regulation, including common law and statutes not specifically directed at regulating medical plans. Read More
Medicare regulations allow MediCal to place a lien on and recover medical expenses it paid for a plaintiff due to injuries suffered by reason of a third party tortfeasor's wrongs. However, the MediCal recovery may be made only from the portion of any recovery by the plaintiff for past medical expenses, not from other portions of the award or settlement. … Read More
The district court erred in granting defendant summary judgment in this False Claims Act case. A genuine issue of triable fact existed as to whether defendant's use of the "KX" modifier in its Medicare reimbursement claims was material. The modifier indicated compliance with local coverage determinations. That certification was false, and it would be material if the trier of fact… Read More
Florida does not violate the Medicare Act by asserting a lien for 37.5% of a Medicare recipient's settlement of his claim against a third party tortfeasor for injuries treated with Medicare benefits. Under Florida law, there is a presumption that 37.5% of any personal injury settlement is paid for past and future medical expenses unless rebutted by clear and convincing… Read More
