Judge Declares CMS Reimbursement Demands 'Unlawful'

A federal trial judge last week issued ruled that the Center for Medicare and Medicaid Services has engaged in unlawful billing practices by making over-inclusive demands for reimbursement from insurance carriers. Pursuant to the Medicare Secondary Payer Act, CMS never bears primary liability for the costs of treating beneficiaries when some other form of insurance is available. Any time CMS pays for a treatment that should have been covered by an insurance carrier, the agency has a statutory right to a recovery from the carrier. For years, CMS has taken the position that its right of r...