The Official Medicare Set Aside Blog And Information Resource

MSA Company Not Liable for Underfunding MSA

CMS, Jen Article, Medicare Set-Asides, Work Comp on August 26, 2016 | Posted by Kimberly Wiswell, CMSP

All these years later and Mr. Bindrum is still mad about his 2008 settlement with AIG. Today an unpublished opinion was reported out of the State of Vermont that shows that after his unsuccessful suit against AIG in federal court for wrongfully delaying his settlement while waiting on CMS approval during the backlog years and […] Continue

Possible furloughs for the Social Security Administration in the future?

Medicare Set-Aside Blog, Social Security on August 12, 2016 | Posted by Jean S. Goldstein, JD

There’s been talk and chatter about the possibility of Social Security Offices and staff being furloughed in the near future.  Nearly three years ago, in 2013, we experienced the government shut down, and extreme delays in the processing of everything from CMS’ review of Medicare Set Asides to Social Security Verifications.  Should furloughs occur in […] Continue

More MSPA Claims 1 Cases Dismissed

Commentary, Medicare Set-Aside Blog, MSP Litigation on August 10, 2016 | Posted by Jennifer Jordan, JD, MSCC

In its continuing efforts to bring MSP recovery claims against all PIP insurers in Florida under an alleged assignment from a now defunct Medicare Advantage Organization, MSPA Claims 1, LLC has had two more of its federal cases dismissed. What is unique about these two dismissals is that they are based on the various assignments […] Continue

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