The Official Medicare Set Aside Blog And Information Resource

MSPA Claims 1, LLC cases Remanded Back to State Court

Commentary, Medicare Set-Aside Blog, MSP Litigation on July 15, 2016 | Posted by Jennifer Jordan, JD, MSCC

In the ongoing pursuit of PIP reimbursements with double damages under the Medicare Secondary Payer Act, two MSPA Claims 1 cases have been remanded back to state court. Because early cases failed in federal court on the basis of plaintiff being required to actually demonstrate responsibility before filing suit, MSPA Claims 1 moved its efforts […] Continue

A Reminder that there is no MSP Reimbursement Obligation Until CMS Makes a Demand

Commentary, Medicare Set-Aside Blog, MSP Litigation on July 14, 2016 | Posted by Jennifer Jordan, JD, MSCC

While always entertained by pro se plaintiffs who take on the man, an interesting MSP opinion came out of the Eastern District of NY on July 11, 2016. Upon receipt of a conditional payment letter, indicating that Medicare had paid $678.60 for treatment related to his accident and in large, bold letters that it was […] Continue

Finally, June 27

CMS, Liability, Medicare Set-Aside Blog on June 27, 2016 | Posted by Jean S. Goldstein, JD

Today is June 27, the first day indicated by CMS as the target date CMS anticipated releasing the adjusted solicitation for the new Workers’ Compensation Review Contractor (WCRC).  We, at MEDVAL, are eagerly awaiting the revised solicitation to determine if in fact the new solicitation will reflect the review of liability MSAs.  We are sitting […] Continue

Medicare Trustees Announce Trust Fully Funded Through 2028

CMS, Medicare, News and Events on June 22, 2016 | Posted by Jennifer Jordan, JD, MSCC

CMS News FOR IMMEDIATE RELEASE June 22, 2016 Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries Medicare Trustees Report Shows Continued Slow Cost Growth Today, the Medicare Trustees projected that the trust fund financing Medicare’s hospital insurance coverage will remain fully funded until 2028, 11 years longer than they projected in 2009 before […] Continue

C&R Rescinded Because Applicant was not Informed of Risks Associated with not Obtaining CMS Approval

Medicare Set-Aside Blog on June 21, 2016 | Posted by Jennifer Jordan, JD, MSCC

A noteworthy panel decision was reported out of California this week involving the WCAB rescinding the WCJ’s order approving the parties’ C&R due to an alleged “mutual misunderstanding” regarding the MSA. The case involved a $39,000 settlement with $11,040 permanent disability advances and $5,858 worth of attorney fees, leaving the applicant with a net recovery […] Continue

WC Settlement Used as Evidence that Claimant was not Disabled for Purposes of Social Security Benefits

CMS, Commentary, Medicare Advantage, Medicare Set-Aside Blog, Social Security on June 16, 2016 | Posted by Jennifer Jordan, JD, MSCC

Ever wonder what happens after a case is settled in which no MSA was funded because the parties all agreed that there was no reasonable anticipation of Medicare entitlement within the magical 30 months from the date of settlement?  The answer is as we all suspected:  the claimant proceeds to apply for Social Security Disability […] Continue

CMS Announces LMSA Review Program

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides on June 10, 2016 | Posted by Jean S. Goldstein, JD

On June 9, 2016, CMS officially validated rumors that it is in fact considering reviewing LMSAs. Announcement of the proposal and subsequent town hall meetings are expected later in the year. The alert (which can be found here) indicated that CMS is considering expanding its voluntary Medicare Set-Aside Arrangements (MSA) amount review process to include […] Continue

The Latest Weapon in the Treatment of Opioid Addiction – Will Probuphine Live Up to the Hype?

Medicare Set-Aside Blog, Rx/Pharmacy on June 6, 2016 | Posted by Erin O'Neill, PA-C, JD

On May 26, 2016, the U.S. Food and Drug Administration (FDA) approved the first implant of its kind designed to provide maintenance treatment of opioid dependence. Probuphine, developed by Braeburn Pharmaceuticals utilizing Titan Pharmaceuticals’ continuous drug delivery system, is a small implant that is made from a mixture of ethylene-vinyl acetate and 80mg of […] Continue

Final Rule Regarding Expansion of the Functionality of the Medicare Secondary Payer Recovery Portal

CMS, Conditional Payments, MSP News on May 19, 2016 | Posted by Erin O'Neill, PA-C, JD

On May 17, 2016, The Centers for Medicare and Medicaid Services (CMS) released the final rule, specifying the timeline and process for expansion of the current Medicare Secondary Payer Recovery Portal. The Final Rule, entitled Medicare Program; Obtaining Final Medicare Secondary Conditional Payment Amounts via Web Portal was published in the Federal Register and can […] Continue

Purdue Pharma Should Have to Supplement MSAs

Commentary, Medicare Set-Aside Blog, News and Events on May 13, 2016 | Posted by Jennifer Jordan, JD, MSCC

On May 11, 2016, Circuit Judge Steven Coms in Pike County, Kentucky, ruled to unseal records related to a 2007 suit brought by the State’s Attorney General against OxyContin manufacturer Purdue Pharma. The suit was settled in December with no admission of liability and a measly $24 million dollar contribution to the state coffers. As […] Continue