The Official Medicare Set Aside Blog And Information Resource

Another Court Case, Perpetuating the Confusion Surrounding LMSAs

CMS, Liability, Medicare Set-Aside Blog, MSP Litigation on November 29, 2017 | Posted by Jean S. Goldstein, JD

Yesterday, a decision came out of the District Court for New Mexico, based upon an action to determine whether a Medicare Set-Aside was needed in a matter involving a personal injury suit.  (Silva v. Burwell, No. 16-cv-488 JCH/KK, 2017 U.S. Dist. LEXIS 195032, (D.N.M. Nov. 28, 2017).)  The applicability of the Medicare Secondary Payer act […] Continue

Visit MEDVAL #3316 at the NWCDC in Las Vegas

Medicare Set-Aside Blog, MEDVAL News on November 27, 2017 | Posted by Jean S. Goldstein, JD

MEDVAL will be exhibiting at the annual National Workers’ Compensation and Disability Conference (NWCDC), December 6th – 8th, 2017 in Las Vegas, Nevada. For a full agenda of the event, visit the conference website here. Stop by our booth #3316 to meet our team, and discuss how we can help solve all of your MSP […] Continue

More MSPA Claims 1 Cases Dismissed for Standing

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on November 27, 2017 | Posted by Jennifer Jordan, JD, MSCC

The U.S. District Court for the Central District of California dismissed the attempted class action against Mercury General on November 2, 2017. As with the other attempted national actions, standing was the fatal flaw in the pleadings as the plaintiffs fail to state who the alleged participating MAOs are. In order to demonstrate standing “[i]n […] Continue

CMS Document SE17019 Reissued; The Effect This Document Has On Your MSA

CMS, Liability, Medicare Set-Aside Blog, MSP News on November 16, 2017 | Posted by Jennifer Alvarez, JD, RN, MSCC, CMSP

As we continue to monitor for guidance from the Centers for Medicare & Medicaid Services (CMS) regarding Medicare Secondary Payer (MSP) compliance and liability/no-fault insurance claims, we have noted a couple of recent changes.  First, on 10/27/17, the CMS Manual System was revised with transmittal 1954 [1], which addressed New Common Working File Medicare Secondary Payer […] Continue

Change is Needed: CWCI Study Provides Concrete Evidence of Over Inclusion of Opioids in WCMSAs

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Opioids, Rx/Pharmacy on November 3, 2017 | Posted by Jean S. Goldstein, JD

This week, the California Workers’ Compensation Institute (CWCI) released a study documenting opioid use in Workers’ Compensation Medical Set-Asides (WCMSAs).  The study (for which MEDVAL contributed both data and advice concerning MSAs) focused on a specific dataset of CMS approved California WCMSAs from 2015 and 2016, against a control group of claims from 2006 through […] Continue

CMS Considering Voluntary Review of Liability MSAs, Again

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on October 26, 2017 | Posted by Jean S. Goldstein, JD

On October 26, CMS once again issued an alert indicating it would be considering expanding the review of voluntary Medicare Set-Asides (MSAs) to include liability insurance and no-fault insurance (LMSAs and NFMSAs).  Just as with other alerts, today’s alert also states that CMS will work closely with the stakeholder community to identify how best to […] Continue

Another New Spin in the MAO Class Actions

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on October 26, 2017 | Posted by Jennifer Jordan, JD, MSCC

MAO-MSO Recovery II, LLC, et al., v. Boehringer Ingelheim Pharmaceuticals, Inc., et al. was dismissed for lack of standing on October 10, 2017. In this latest MSP private cause of action stemming from the Florida Health Care Plus assignment, this claim sought recovery from the Predaxa MDL settlement that occurred in May 2014. Predaxa is […] Continue

Another Michigan Spine Case

Medicare Set-Aside Blog, MSP Litigation, MSP News on October 16, 2017 | Posted by Jennifer Jordan, JD, MSCC

Opinion out of the U.S. District Court for the Eastern District of Michigan reported on October 13, 2017 shows that the Michigan Spine and Brain Institute is at it again. You may recall that in 2013, there were a series of opinions stemming from a situation in which Michigan Spine was denied payment, billed Medicare […] Continue

Class Action MAO Recoveries Are Continuing

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on October 13, 2017 | Posted by Jean S. Goldstein, JD

On August 10, 2017, MSP Recovery Claims, LLC filed a class action complaint against Safeco Insurance Company of America in a Florida Circuit Court.  Yesterday, the Defendants filed a request for removal of the matter to Federal Court.  (MSP Recovery Claims, Series LLC v. Safeco Insurance Company of America, Case 1: 17-cv23738-UU). As we have […] Continue

New Medicare Secondary Payer Recovery Contract Awarded

CMS, CRC, Medicare Set-Aside Blog, MSP News on October 9, 2017 | Posted by Jean S. Goldstein, JD

On October 5, the Centers for Medicare and Medicaid Services (CMS) awarded Performant Financial Corporation the Commercial Recovery Center (CRC) contract.  The contract was previously awarded to CGI Federal two years ago, when the CRC expanded and assumed responsibility for conditional payment recovery activities directly from Non-Group Health Plans (NGHPs). Performant is not a new […] Continue