Medicare Compliance & Reimbursement
MSP BLUES
The Department of Justice Feb. 11 partially intervened in a whistleblower suit accusing Pittsburgh, PA-based insurer Highmark Inc. of playing fast and loose with Medicare Secondary Payer rules — and demoting the woman charged with ensuring that the company complied with MSP requirements.
The case was originally filed in 2000 by Elizabeth Drescher, a Highmark employee charged, according to the lawsuit, with overseeing the company’s compliance with MSP rules in the wake of a 1995 agreement between the feds and a number of Blue Cross and Blue Shield plans, including Highmark’s predecessor company. The lawsuit maintains that serious MSP compliance concerns were well-known to company leaders, but that after announcing that it would fix the problem, Highmark demoted Drescher and removed her from all responsibility for MSP issues.
Drescher responded by filing a whistleblower suit accusing Highmark of knowingly underpaying the amounts due for care provided to certain Medicare beneficiaries under employer group health plans the company insured or administered. The DOJ intends to file an amended complaint in the matter.
Highmark denies the charges, according to news reports.
Medicare Compliance & Reimbursement
- Reimbursement:
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MSP BLUES
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