RAMP Act: Transforming Medicare Secondary Payer Claims Impact

Insurance Industry Update on the RAMP Act and Its Impact on Medicare Secondary Payer Claims

In recent legislative developments, the RAMP Act, spearheaded by Senators Tim Scott (R-SC) and Maggie Hassan (D-NH), aims to amend Medicare Secondary Payer (MSP) regulations. This proposed legislation, following its introduction by Representatives Gus Bilirakis (R-FL) and Brad Schneider (D-IL), targets a pivotal change in the private cause of action under 42 U.S.C. § 1395y(b)(3)(A). By focusing on group health plans exclusively, the RAMP Act seeks to reshape the current inclusion of any "primary plan," a move prompted by the Medicare Advocacy Recovery Coalition's (MARC) efforts.

The proposed amendment is expected to impact the insurance industry by reducing litigation exposure for non-group health plan (NGHP) insurers. Over the past decade, Medicare Advantage Plans (MAPs) have utilized the private cause of action to claim "double damages" from insurers, leading to significant litigation volumes. The RAMP Act's anticipated restriction could thus streamline risk management strategies by minimizing legal liabilities associated with MAP recovery claims.

Moreover, the RAMP Act endeavors to clarify ongoing disputes about claim initiation rights and the legitimacy of seeking double damages under the current MSP regulations. As stakeholders like the Verisk policy team monitor the bill’s progress through Congress, the insurance industry remains poised to adjust compliance strategies. By modernizing MSP regulations, the RAMP Act could bring about substantial changes in the insurer-payer-provider dynamics, emphasizing the importance of regulatory compliance requirements amid evolving Medicare reimbursement claim processes.