1. NASP 2010 Subrogation Litigation: Skills & Management Conference
The Third Rail of Subrogation:
Medicare and Medicaid
Nathan Krahn/Associate General Counsel
Ingenix

2. Introduction and Agenda
Medicare Secondary Payor Act Basics
Impact of the MMA 2003
Does the MSP apply to Medicare Advantage Plans?
Medicare Litigation Update
Medicaid TPL Basics
Post Ahlborn cases
Medicaid Litigation Update
Questions

3. Medicare Secondary Payor Act (MSP) Basics
The Medicare Secondary Payer Act
What it does:
What rights it confers for subrogation/reimbursement:
Code of Federal Regulations: Additional rights and procedures

4. Changes post-MMA of 2003
What changed?
What is the practical impact?

5. National Litigation Update
Published Cases
Current Litigation

6. Medicaid: Third Party Liability (TPL) Structure
TPL regime is required by federal law
Common requirements and structures
Many states have “state funds only” Medicaid-like” plans which are governed exclusively by state law.

7. Hottest topic in Medicaid recovery
Alhborn and its impact
Summary of Ahlborn:
Ahlborn’s basic legal rule:

8. Post Ahlborn cases
Several state and federal courts have used the Ahlborn analysis for Medicaid matters
Several state and federal courts have not used Ahlborn, or at least distinguished Ahlborn’s holding.

9. National Litigation Update
Cases dealing with scope and reach of Ahlborn

10. Conclusion
MSP rights and powers are expanding and should expand under federal healthcare reform.
Medicaid TPL laws will be strengthened due to state budget woes, so look for those changes.

11. THANK YOU… QUESTIONS?