PMSI backs off claims

Medicare Set-Aside Blog on May 19, 2010
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It seems our friends at PMSI have toned down the “we did it” rhetoric a little with this blast email. Apparently someone over there heard the laughing and realized the backlash their original marketing had on their credibility. Wisely someone over there ordered a quiet recision of prior statements.

May 18, 2010


PMSI issued a press release on Monday, May 17, 2010 regarding the recent memorandum from the Centers for Medicare and Medicaid Services (CMS) on Medicare Set-Aside (MSA) allocations, clarifying the exclusion on non-Medicare Part D covered prescription drugs from MSA calculations.

Together with payors and other industry experts, PMSI Settlement Solutions has led an advocacy effort to influence CMS in adopting revised guidelines in order to increase the accuracy and predictability of MSAs, leading to changes such as this recent announcement. PMSI will continue to engage in active dialogue with CMS on further refinement of the MSA drug review process and other issues impacting MSA allocations.

For further information, click here to view the press release.

Should you have any questions or would like further information, please email us at

In the interim, I have been enjoying heated email exchanges with Joe Paduda about the post that set off this issue. Paduda would like me to PROVE that his post is incorrect which is obviously hard to do other than getting Gerald Walters to issue a statement saying PMSI was not the proximate cause of CMS’ change of heart. I wouldn’t hold my breath waiting for that to happen

We believe the proximate cause of the change was the passage of P.L. 111-148  Patient Protection and Affordable Care Act.
This law clarified the Medicare coverage guidelines for off-label usage which was strikingly similar to the text of their internal memo. Even CMS believes it sometimes needs to follow the law in the WCRC review process.  

However, as I explained to Mr. Paduda, I may not have all the facts in this matter. He claims to have compelling evidence to support his original blog post. I would be most appreciative if  Dr. Takemoto, MD would share a timeline of his advocacy efforts along with supporting evidence with Mr. Paududa. I would also appreciate any evidence our readership would be willing to share in support or rebuttal of the claims made by PMSI and Mr. Paduda.

I would be happy to give PMSI and Takemoto, MD public credit and an apology if any of my statements turn out to be uniformed or untrue. This blog seeks, in part, to uncover the truth and expose the marketing spin employed by some in this industry. If in fact, Dr. Takemoto, MD is deserving of all the credit for spearheading this change, I would like the honor of giving it to him.


On another note, we have published our internal opinion on how this memo will likely affect claims handling in the near term. Email me at if you would like a copy.