The Official Medicare Set Aside Blog And Information Resource

Another Michigan Spine Case

Medicare Set-Aside Blog, MSP Litigation, MSP News on October 16, 2017 | Posted by Jennifer Jordan, JD, MSCC

Opinion out of the U.S. District Court for the Eastern District of Michigan reported on October 13, 2017 shows that the Michigan Spine and Brain Institute is at it again. You may recall that in 2013, there were a series of opinions stemming from a situation in which Michigan Spine was denied payment, billed Medicare […] Continue

Class Action MAO Recoveries Are Continuing

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on October 13, 2017 | Posted by Jean S. Goldstein, JD

On August 10, 2017, MSP Recovery Claims, LLC filed a class action complaint against Safeco Insurance Company of America in a Florida Circuit Court.  Yesterday, the Defendants filed a request for removal of the matter to Federal Court.  (MSP Recovery Claims, Series LLC v. Safeco Insurance Company of America, Case 1: 17-cv23738-UU). As we have […] Continue

New Medicare Secondary Payer Recovery Contract Awarded

CMS, CRC, Medicare Set-Aside Blog, MSP News on October 9, 2017 | Posted by Jean S. Goldstein, JD

On October 5, the Centers for Medicare and Medicaid Services (CMS) awarded Performant Financial Corporation the Commercial Recovery Center (CRC) contract.  The contract was previously awarded to CGI Federal two years ago, when the CRC expanded and assumed responsibility for conditional payment recovery activities directly from Non-Group Health Plans (NGHPs). Performant is not a new […] Continue

Full Medicaid Recovery Coming to a Claim Near You: October 1st

Conditional Payments, Medicaid, Medicare, Medicare Set-Aside Blog, MSP News on September 25, 2017 | Posted by Jean S. Goldstein, JD

As we have seen, Medicare Advantage Plans, Military/Governmental Healthcare Providers, and Private Insurers are aggressively pursuing liens with a priority right approach to recovery.  We often discuss these entities in the context of being a secondary payer, and the omnipresent concern that these entities will seek reimbursement of payments that have been conditionally made, when […] Continue

NEW Workers’ Compensation Review Contractor (WCRC) Contract Awarded

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on September 5, 2017 | Posted by Jean S. Goldstein, JD

Finally, a new Workers’ Compensation Review Contractor (WCRC) award has been issued.  This news comes after several months of work being completed by Provider Resources, the incumbent contractor, under an expired contract.  The new WCRC contract was awarded on September 1, 2017 to Capitol Bridge, LLC of Arlington, Virginia, a certified small business entity.  Capitol […] Continue

Settling a Case in Arizona?  What You Need to Know About Full & Final Settlements

Medicare Set-Asides, MSP News, State Regulations on August 3, 2017 | Posted by Jean S. Goldstein, JD

Historically, workers’ compensation claims in Arizona have been subject to a number of limitations.  If additional medical treatment was needed, a claimant could reopen a claim at any time, despite the finality and resolution of the claim.  As a result, settlement of workers’ compensation claims in Arizona have been far less common because these claims […] Continue

New WCMSA Reference Guide Issued

CMS, Medicare, Medicare Set-Asides, MSP News, Re-Review Process on August 1, 2017 | Posted by Jean S. Goldstein, JD

As you may be aware, on July 10th, here on our blog we announced the quiet release of a change to CMS’ re-review process.  However, as we noted at that time, this process was not formalized by CMS, and had simply been released through CMS’ Workers’ Compensation Medicare Set-Aside Portal (WCMSAP).  Specifically, through a revised WCMSAP User Guide, […] Continue

Endo Pharmaceuticals Voluntarily Withdraws Opana ER From the Market: What Does This Mean For Your Cases?

CMS, Medicare Set-Aside Blog, MSP News, Opioids, Re-Review Process on July 11, 2017 | Posted by Erin O'Neill, PA-C, JD

On July 6, 2017, Endo Pharmaceuticals issued a statement indicating it would voluntarily withdraw the opioid pain medication, Opana ER, from the market, in response to the Food and Drug Administration’s request one month earlier. As noted in our prior blog post, the FDA requested that Endo Pharmaceuticals withdraw Opana ER from the market, citing concerns of […] Continue

Eyes on the Prize: A New CMS Re-Review Option is Available.

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on July 10, 2017 | Posted by Jean S. Goldstein, JD

While all eyes (and ears) have been focused on the news, or the lack thereof of news regarding the Workers’ Compensation Review Contractor award, CMS quietly released a change to their re-review process today.  The change was released through CMS’ Workers’ Compensation Medicare Set-Aside Portal (WCMSAP).  Specifically, through a revised WCMSAP User Guide, which can […] Continue