Using Technology to recover Medicare Secondary Payer Funds
President Lyndon B. Johnson signed Medicare into law in 1965 with H.R. 6675 (20 years after Harry S Truman started fighting for a bill in Congress in 1945). The first year budget was $10 billion in 1965.
There are special Medicare eligibility rules for people with end-stage renal disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease). People with disabilities have to wait for Medicare coverage, but Americans with ESRD can get coverage as early as three months after they begin regular hospital dialysis treatments
In 1980, Congress passed legislation that made Medicare the secondary payer to certain primary plans in an effort to shift costs from Medicare to the appropriate private sources of payment. The MSP provisions have protected Medicare Trust Funds by ensuring that Medicare does not pay for items and services that certain health insurance or coverage is primarily responsible for paying. The MSP provisions apply to situations when Medicare is not the beneficiary’s primary health insurance coverage. Medicare statute and regulations require that all entities that bill Medicare for items or services rendered to Medicare beneficiaries must determine whether Medicare is the primary payer for those items or services.
Since 1997, Medicare enrollees have had the option of opting for Medicare Advantage instead of Original Medicare. Medicare Advantage plans often incorporate additional benefits, including Part D coverage and extras such as dental and vision. And unlike Original Medicare, the plans do include a cap on out-of-pocket costs that can’t exceed $7,550 in 2021.
As of 2020, there were more than 24 million Americans enrolled in Medicare Advantage plans, accounting for about 36 percent of all Medicare beneficiaries. And the federal government expects Medicare Advantage enrollment to grow to 26 million in 2021.
The Medicare Modernization Act of 2003 changed the name to Medicare Advantage, but the concept is still the same: beneficiaries receive their Medicare benefits through a private health insurance plan, and the health insurance carrier receives payments from the Medicare program to cover beneficiaries’ medical costs.
Filing a class-action lawsuit against Glaxo, Humana sought to recover expenses it paid for members who were allegedly harmed by the controversial diabetes drug Avandia, which has been linked to increased risk of heart damage.
Humana as a Medicare Part C provider ("MAO") can pursue a lawsuit against GlaxoSmithKline after the U.S. Supreme Court refused to hear the pharmaceutical giant's appeal of a lower court decision that let the insurer's suit proceed.
CMS Medicare reports $100 billion in "unidentified payments" a year which may benefit from using technology to recover these funds utilizing "Legal Blockchain" technologies.
CirclesX - Foodie Body Research - Dementia and Alzheimers Statistics are compelling. Up to 80% of the beta amyloid buildup can be reversed which increases cognitive ability.
CMS Medicare reports $100 billion in "unidentified payments" a year which may benefit from using technology to recover these funds utilizing "Legal Blockchain" technologies.
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