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
On June 8, 2017, the Food and Drug Administration (FDA) requested that Endo Pharmaceuticals withdraw Opana ER from the market, citing concerns of ongoing misuse and abuse of the drug. As you will recall from our prior blog post, in March 2017, an FDA advisory committee found that the risks associated with use of Opana ER […] Continue
We are currently four months away from CMS implementing their new workflows for Medicare Administrative Contractors (MACs), which outline how they will handle bills when there is a Liability Insurance Medicare Set-Aside Arrangement (LMSA) or No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA) involved in the settlement. You may be aware that, in February 2017, CMS took […] Continue
As reported several months ago, CMS has begun preparation of a new fraud prevention initiative that removes Social Security numbers (SSN) from all Medicare cards. This initiative is the result of the passage of the Medicare Access and CHIP Reauthorization Act of 2015, which mandated the removal of the SSN-based HICN from Medicare cards. Known […] Continue
On May 3, 2017, the U.S. District Court for the Central District of California issued its order with regard to CIGA’s entitlement to relief following the court’s award of partial summary judgment in January. Based upon briefing submitted following that ruling, the Court concluded that CIGA is entitled to: an order vacating and setting aside […] Continue
Nationwide, states and workers’ compensation boards have been taking measures to curb the overprescribing and misuse of opioids and the crisis that has ensued as a result. Nonetheless, opioid addiction continues to be a growing concern. In an effort to help states combat the opioid epidemic, the U.S. Department of Health and Human Services (HHS) […] Continue
For the past year or so, we have watched courts treat Medicare Advantage Organizations (MAOs) as if they were on equal footing as the federal government acting in the best interest of the Medicare Trust Funds. The courts have manipulated murky laws and regulations to give MAOs reimbursement rights that Congress did not expressly address […] Continue
For the second year in a row, MEDVAL has been chosen by workerscompensation.com as one of the best MSP blogs in the workers’ compensation industry. Blogs were nominated by members of the workers’ compensation community and judged by an independent judging panel of seven highly respected industry leaders. We want to thank all of our […] Continue
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
Senate Bill 760, or Act 1058 (“the Act”) was signed into law on April 7, 2017. The initial purpose of the Act was to clarify the Workers’ Compensation Death and Permanent Total Disability Trust Fund. However, the bill was revised to expand the Arkansas Workers’ Compensation Commission’s ability to consider and finalize specific settlements. Act […] Continue