The Official Medicare Set Aside Blog And Information Resource

CMS Publishes Self-Administration Toolkit

CMS, Medicare Set-Aside Blog, MSP News on April 11, 2014 | Posted by Jennifer Jordan, JD, MSCC

On April 11, 2014, CMS added an entire subsection to its WCMSA website for self-administration help. In the agency’s usual overreaching style, it has created requirements that are not supported by any law or regulation. While many of its suggestions are certainly the most logical approach to self-administering an MSA, the tone of the agency [...] Continue

Zohydro ER – The New Actiq

CMS, Commentary, Medicare Set-Aside Blog, Rx/Pharmacy on April 4, 2014 | Posted by Jennifer Jordan, JD, MSCC

Yesterday MEDVAL did its first MSA evaluation for a California applicant taking Zohydo ER. We were genuinely shocked as this drug was not even expected to hit the market until March so we didn’t really anticipate seeing it included in MSAs until maybe the end of the year, if at all if common sense prevailed. [...] Continue

Louisiana Attorneys Seek MSA Seed Money as Fee

Commentary, Medicare Set-Aside Blog on March 24, 2014 | Posted by Jennifer Jordan, JD, MSCC

On March 19, 2014, the Court of Appeal of Louisiana affirmed an OWC ruling denying two attorneys a request for their fee. While attorneys are frequently criticized for the amounts they take from settlements, no one expects them to work for free. But when it is their own negligence that leaves them unpaid, well there’s [...] Continue

Improperly Exhausted MSA by Sister while Claimant in Jail not Dischargeable in Sister’s Bankruptcy

Commentary, Medicare Set-Aside Blog, Medicare Set-Asides, MSA Administration on March 13, 2014 | Posted by Jennifer Jordan, JD, MSCC

That got your attention, didn’t it? This is an argument against self-administration that no one is really giving proper consideration. The story goes like this: Stephen Hubanks was an appliance serviceman for GE in the late 1990s when he suffered a back injury and ended up on comp. Admirably he was able to return to [...] Continue

PA Court Acknowledges Need for Administrative Remedy Exhaustion

Medicare Set-Aside Blog, MSP Litigation on February 27, 2014 | Posted by Jennifer Jordan, JD, MSCC

On February 24, 2014, the US District Court for the Eastern District of Pennsylvania denied a motion for interpleader of HHS on the basis that administrative remedies under the Medicare Act had not been exhausted. The case involves a FELA claim in which a NJ Transit worker contracted esophageal cancer and died as a result. [...] Continue

CMS Alert Changes Reporting Threshold

CMS, Medicare Set-Aside Blog on February 20, 2014 | Posted by Jennifer Jordan, JD, MSCC

Due to an overwhelming number of inquiries today, we want to clarify that the February 18, 2014 Alert does expressly state that “physical trauma-based liability settlements of $1000 or less do not need to be reported….” The Alert also specifically states that “[the content of this Alert supersedes the content of the existing Medicare Secondary [...] Continue

Better Late Than Never – CMS Establishes $1,000 Safe Harbor

Medicare Set-Aside Blog on February 19, 2014 | Posted by Jennifer Jordan, JD, MSCC

Pursuant to Section 202 of the Smart Act, the Secretary is supposed to determine the average settlement amount where the cost of recovery most closely meets the recovery amount and set the reporting threshold to that amount annually. By no later than November 15th of each year, the Secretary is supposed to report to Congress [...] Continue

RIMS Submits Recommendations for Imposing Smart Act Tax Penalties

CMS, Medicare Set-Aside Blog, News and Events on February 19, 2014 | Posted by Jennifer Jordan, JD, MSCC

RIMS Letter to Centers for Medicare and Medicaid Services Reinforces its Commitment to Streamlining the Insurance Process   NEW YORK (February 18, 2014) – RIMS, the risk management society ™, delivered an official letter to the Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) highlighting recommendations to fairly impose tax [...] Continue

Delaware Court Reminds Us of MSP Basics

Medicare Set-Aside Blog, MSP Litigation on February 19, 2014 | Posted by Jennifer Jordan, JD, MSCC

On January 23, 2014, the Superior Court of Delaware for Kent County dismissed an amended complaint seeking double damages under 42 U.S.C. 1395y(b)(3)(A). While hopeful that this opinion would further recent trends holding that both express conditions in the statute must be met in order to bring this action, meaning involving an Medicare exclusion and [...] Continue

Medicare Advantage Claims Under MSP Preempt Arizona’s Anti-Subrogation Doctrine

Medicare Set-Aside Blog, MSP Litigation on February 18, 2014 | Posted by Kimberly Wiswell

In the ongoing evolution of case law concerning Medicare Advantage Plans and their recovery rights under the Medicare Secondary Payer Act (MSP), the Supreme Court of Arizona has determined that a Medicare Advantage plan may recover medical expenses from its enrollees’ personal injury settlements despite Arizona’s anti-subrogation doctrine, a common law doctrine that bars the [...] Continue