The Official Medicare Set Aside Blog And Information Resource

THE UR/IMR PROCESS: STILL GOOD ON ITS FACE.

CMS, Independent Medical Review, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Work Comp on June 21, 2017 | Posted by Jean S. Goldstein, JD

The California Supreme Court has determined that it will not review a case involving an injured worker who asserted that the Independent Medical Review (IMR) process was unconstitutional.  This is good news for California payers, furthering the defensive position that payers can continue to rely on both the Utilization Review (UR) and Independent Medical Review […] Continue

$40 Million Dollars Paid by Insurance Carriers and 13,000 California Patients Affected in an Alarming Kickback Scheme

Fraud, Medicare Set-Aside Blog, Work Comp on April 21, 2017 | Posted by Jean S. Goldstein, JD

Yesterday, 26 defendants (21 doctors, 2 pharmacists, 1 physician assistant, and 2 business owners) were criminally charged in connection with a 40-million-dollar kickback scheme affecting 13,000 California patients statewide.  Two defendants, Tanya King and Christopher King “the Kings”, allegedly masterminded a complex insurance fraud scheme by recruiting both pharmacists and doctors to prescribe medically unnecessary […] Continue

Visit MEDVAL at the National Workers’ Compensation and Disability Conference (NWCDC)

Medicare Set-Aside Blog, MEDVAL News, News and Events, Work Comp on November 10, 2016 | Posted by Jean S. Goldstein, JD

The NWCDC is just 20 days away! The event kicks off on November 30, and will be held at the New Orleans Ernest N. Morial Convention Center.  For a full agenda of the event, visit the conference website here. On Thursday, December 1, Jennifer Jordan, our Chief Legal Officer, will be speaking about ways to […] Continue

MEDVAL Speaking and Exhibiting at the National Workers’ Compensation and Disability Conference & Expo

Medicare Set-Aside Blog, MEDVAL News, News and Events, Work Comp on October 14, 2016 | Posted by Jean S. Goldstein, JD

For 24 years, the National Workers’ Compensation and Disability Conference & Expo (NWCDC) has been one of the leading training events for workers’ compensation and disability management professionals.  MEDVAL is pleased to be a presenter, exhibitor, and event sponsor of the 25th Annual NWCDC in New Orleans next month. Jennifer Jordan, our Chief Legal Officer, […] Continue

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

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

Management of Opioid Induced Hyperalgesia – The Impact on Workers’ Compensation Claims

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Rx/Pharmacy, Work Comp on November 9, 2015 | Posted by Abidemi Oyebode, R.Ph., MBA - Clinical Pharmacist

The impact of opioid use in workers’ compensation claims has been widely researched and the shocking results continue to reveal that opioid use remains a very significant concern for workers’ compensation carriers. As evidenced by the NCCI Workers’ Compensation Prescription Drug Study: 2013 Update, the average narcotic cost per claim continued to increase as did […] Continue

CMS Will Not Finalize the Draft Lower Limb Prostheses Local Coverage Determination DL33787

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Work Comp on November 4, 2015 | Posted by Erin O'Neill, PA-C, JD

On November 2, 2015, the Centers for Medicare and Medicaid Services (CMS) announced that the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) will not finalize the draft Lower Limb Prostheses Local Coverage Determination (LCD) DL 33787 at this time. This decision comes after a severe backlash from numerous stakeholder organizations regarding the proposed LCD. […] Continue

WC Opt Outs and MSAs

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Work Comp on October 29, 2015 | Posted by Jennifer Jordan, JD, MSCC

In a recent blog post by Bob Wilson at WorkersCompensation.com [http://www.workerscompensation.com/compnewsnetwork/from-bobs-cluttered-desk/22602-federal-intervention-in-workers%E2%80%99-comp-will-opt-out-be-the-final-straw.html] about the opt out movement across the nation, he cautioned that federal intervention is probably not the solution to the workers’ compensation problem, citing the CMS oversight of MSAs as a prime example of why. But what I found interesting was that Bob likely […] Continue

MEDVAL to Attend the National Workers’ Compensation & Disability Conference & Expo

Medicare Set-Aside Blog, MEDVAL News, Work Comp on October 29, 2015 | Posted by Kimberly Wiswell, CMSP

An estimated 2,000 plus participants are expected to attend the National Workers’ Compensation and Disability Conference & Expo (NWCDC) in Las Vegas next month. In its 24th year, this is the leading event for workers’ compensation and disability management professionals. MEDVAL is pleased to be both an exhibitor and event sponsor. We invite you to […] Continue