The Official Medicare Set Aside Blog And Information Resource

CMS Updates Unified Agenda Regarding Date for Civil Money Penalty Provisions for MSP Reporting Requirements

CMS, Mandatory Insurer Reporting, MSP News on August 12, 2019
Posted by Jean S. Goldstein, JD

Last week, we provided an update that the Centers for Medicare and Medicaid Services (CMS) updated the Unified Agenda as related to the proposed rulemaking for guidance regarding how to satisfying Medicare Secondary Payer (MSP) obligations. The Unified Agenda was also recently updated with respect to the proposed rule regarding civil money penalties for MSP […] Continue


Liability, MSAs, MSP News on August 6, 2019
Posted by Jean S. Goldstein, JD

In the end of 2018, we reported that the Centers for Medicare & Medicaid Services (CMS) added an item to the Unified Agenda, which is semiannual compilation of information about regulations under development by federal agencies.  The Unified Agenda is published in both the spring and fall.  The item added was a notice regarding an […] Continue

Submitting a WCMSA with Lyrica to CMS for Approval? Generic Lyrica (pregabalin) Now Available in CMS’ WCMSA Portal

CMS, Rx/Pharmacy on August 2, 2019
Posted by Jean S. Goldstein, JD

You may recall our blog from last week announcing the long awaited FDA approval of generic versions of the drug, Lyrica (pregabalin).  While the FDA’s announcement sparked joy among all in the workers’ compensation industry, it was not until today that pregabalin became available for pricing and allocation in CMS’ maintained Workers’ Compensation Medicare Set-Aside […] Continue

First Circuit, Massachusetts Court: Assignee of Medicare Advantage Plan May Bring Private Cause of Action for Double Damages

Conditional Payments, Medicare Advantage, MSP Litigation on July 31, 2019
Posted by Jean S. Goldstein, JD

Earlier this month, the United States District Court for the District of Massachusetts issued a ruling on a Motion to Dismiss and Motion to Strike Class Allegations involving an insurance carrier and a Medicare Advantage Organization (MAO).  The United States District Court for the District of Massachusetts sits in the First Circuit, which includes the […] Continue

FDA Approves Generic Versions of Lyrica

FDA, Medicare Set-Asides, Rx/Pharmacy on July 24, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

On Monday, the FDA issued a press release announcing the approval of generic versions of the drug Lyrica (pregabalin). Those of us operating in the workers compensation industry are all too familiar with Lyrica. It’s a high-priced medication utilized for the treatment of pain related to nerve damage, and its inclusion within Workers’ Compensation Medicare […] Continue