Lexis released an opinion this morning from a December New Jersey state court ruling approving a liability Medicare set-aside arrangement. The opinion arises out of a September 2012 mediation in which the parties were able to arrive at a settlement but were unable to consummate the settlement because the settlement “contemplated a determination by the [...] Continue
On May 15, 2013, Congressmen Reichert and Thompson introduced H.R. 1982 into the House of Representatives. I have run a pdf comparison on this bill and H.R. 5284 and have found it to be substantially the same bill, making this the fourth try in consecutive Congresses with little track record of progress. Regardless of some [...] Continue
On May 14, 2013, the much awaited 5th Circuit appellate decision was filed in Caldera v. The Insurance Company of the State of Pennsylvania (ICPS), finding in favor of state workers’ compensation law over the Medicare Secondary Payer Act. As a reminder since it has been considerable time since the original decision, this case involved [...] Continue
While a huge win for Purdue Pharma, I’m not seeing the small WC win reported in Risk & Insurance this week regarding the FDA’s refusal to approve generic versions of OxyContin. Much like the original version of OxyContin approved in 1995, these generics could be easily crushed into a powder, making it more susceptible to [...] Continue
Well it looks like the Supreme Courts may get a third bite at the apple on another Medicare issue. On April 19, 2013, the 9th Circuit Court of Appeals upheld the Arizona District Court opinion in Parra v. PacifiCare that Medicare Advantage Organizations (MAO’s) cannot bring a private cause of action under the MSP to [...] Continue
…and got her case dismissed this week by the US District Court for the Eastern District of New York. No brainer given lack of subject matter jurisdiction, but since the court felt compelled to write an opinion (although labeled not for publication), I felt compelled to share it with you. You see, Maria L. Banks-Gervais [...] Continue
For those of you in states that allow prescription, the 2008 decision in Reed v. Mid-States Wood Preservers, Inc. was a wake up call to understand that MSAs may have other unanticipated and unintentional affects on claims and settlement negotiations. In that case, the act of having multiple MSAs prepared and disclosed to the claimant [...] Continue
What does it take to get the Supreme Court to listen to an MSP case anyway? On April 15, 2013, the Supreme Court denied cert in In re Avandia. While I don’t disagree with their decision, I do share in the industry frustration over not being able to get before the high court. Any statutory [...] Continue
Yesterday, CMS issued the following alert: On October 2, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Sponsors concerning the transition to Part D Coverage of Benzodiazepines and Barbiturates beginning in 2013. Effective June 1, 2013, all Workers’ Compensation Medicare Set-Aside (WCMSA) proposals submitted to CMS for a [...] Continue
CMS relies heavily upon the basic premise of the Supremacy Clause in that the MSP is a federal law and, as a general proposition, supersedes state law. However, I frequently question the extent of the applicability to MSP debt given that the claims that give rise to the reimbursement obligation are governed by state law. [...] Continue