The Official Medicare Set Aside Blog And Information Resource

A portent of things to come? CMS releases revised WCRC contract pre-solicitation

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, News and Events on April 19, 2016 | Posted by Kimberly Wiswell, CMSP

CMS has revised their pre-solicitation for the WCRC contract with the following statement: ATTENTION: RFP-CMS-2016-8A-0008 PRE-SOLICITATION notice has been updated as follows. The Centers for Medicare and Medicaid Services (CMS) has adjusted the referenced solicitation for the Workers’ Compensation Review Contractor (WCRC) due to updates that are currently being made to the Statement of Work (SOW) […] Continue

Additional Updates to the WCMSA Reference Guide

CMS, ICD-10, Medicare Set-Aside Blog on April 18, 2016 | Posted by Jean S. Goldstein, JD

An updated and revised WCMSA reference guide was just issued today.  The revised guide, version 2.5, can be found here. The revised WCMSA reference guide has two minor updates, both of which CMS has been addressing in the past couple of months, and which we have discussed here on our blog.  The first update piggybacks […] Continue

The Opioid Crisis: A Call to Action

Rx/Pharmacy on March 25, 2016 | Posted by Abidemi Oyebode, R.Ph., MBA - Clinical Pharmacist

The National Survey on Drug Use and Health (NSDUH) showed that in 2012 about 2.1 million Americans were addicted to opioid pain medications, roughly 467,000 addicted to heroin and about 2.5 million Americans with opioid use disorder but receiving legitimate prescriptions.  According to the CDC, opioids were involved in 16, 235 deaths in 2013 and […] Continue

FDA to Require Black Box Warning on All Immediate-Release Opioid Medications

Medicare Set-Aside Blog, MSP News, News and Events, Rx/Pharmacy on March 22, 2016 | Posted by Erin O'Neill, PA-C, JD

On Tuesday, March 22, 2016, the U.S. Food and Drug Administration (FDA) announced it will now require a black box warning on all immediate-release opioid medications. This warning will address issues regarding the risks of abuse, addiction, misuse, overdose and death. The FDA had indicated that immediate-release opioid medications should be reserved for individuals with […] Continue

H.R. 2649 Update

CMS, Commentary, Medicare, Medicare Set-Aside Blog on March 14, 2016 | Posted by Jennifer Jordan, JD, MSCC

On March 7, 2016, H.R. 2649: Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2015 found itself a new co-sponsor. Representative John Larson of Connecticut joined the ranks of congressmen that now know what a Medicare set-aside is and don’t care that there is no legal requirement to participate in the voluntary CMS […] Continue

U.S. Supreme Court ERISA Ruling Instructive to Opt-Out Proponents

Commentary, Medicare Set-Aside Blog, State Regulations, Work Comp on March 4, 2016 | Posted by Jennifer Jordan, JD, MSCC

Although not our standard MSP fare, the U.S. Supreme Court ruling on March 1, 2016, in Gobeille v. Liberty Mutual Insurance Company caught my attention nonetheless as potentially interesting to our work comp readers so here goes. The Court ruled that ERISA reporting requirements preempted a Vermont law that requires certain entities to report payments […] Continue

Medicare Recovers Despite Failure to Treat Being the Claim

CMS, Commentary, Liability, Medicare, Medicare Set-Aside Blog, MSP Litigation on March 4, 2016 | Posted by Jennifer Jordan, JD, MSCC

Alleging medical damages and receiving compensation for release from liability for those same medical damages will result in reimbursing Medicare for related medical expenses pretty much regardless of your legal theory as to why you should keep that windfall rather than the federal government. On March 3, 2016, the U.S. District Court for the Eastern […] Continue

NGHP Mandatory Insurer Reporting Reminder: Report Recovery Agent Information in Designated Fields

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog on March 3, 2016 | Posted by Jessica M. Wingenroth, JD

CMS is reminding RREs to use the designated Recovery Agent reporting fields that were implemented on 07/13/15, and not the TIN Reference File fields previously employed as a workaround. If the Third Party Administration (TPA) workaround was utilized in the past, RREs are required to resubmit all TIN Reference File records that are corrected to […] Continue

NJ District Court Permits False Claims Act Suit Against Progressive to Continue

CMS, Commentary, Medicare, Medicare Set-Aside Blog, MSP Litigation on March 2, 2016 | Posted by Jennifer Jordan, JD, MSCC

On March 1, 2016, the U.S. District Court for the District of New Jersey denied a motion to dismiss in a False Claims Act (FCA) suit against Progressive Insurance, essentially granting standing to the relators. Case involves Progressive “health first” auto policies sold online in New Jersey that caused Medicare to be billed as primary […] Continue