The Official Medicare Set Aside Blog And Information Resource

Will the Expansion of Telehealth Services Lead to More Conditional Payments?

CMS, Conditional Payments, Medicare Set-Aside Blog, Telehealth on March 30, 2020
Posted by Jean S. Goldstein, JD, CMSP

In 2019, Medicare started covering some virtual care services. The services covered included brief communications and Virtual Check-Ins (short patient-initiated communications with a healthcare practitioner) along with E-visits (which are non-face-to-face patient-initiated communications through an online patient portal). However, telehealth services have generally not been covered. Historically, for telehealth services to be covered, certain circumstances […] Continue

Workers’ Compensation Board Says “No” to Medicare Hold Harmless Language in Settlement Agreements

Conditional Payments, Medicare Set-Aside Blog, MSP News on March 4, 2020
Posted by Jean S. Goldstein, JD, CMSP

On Monday, the New York State Workers’ Compensation Board issued a bulletin that announced that the Board would no longer approve Section 32 Waiver Agreements that required the claimant to indemnify and hold the Carrier harmless for any payment made by Medicare for treatment of claimant’s work-related injuries before the execution of the Agreement.  The […] Continue

Eleventh Circuit Finds Medicare Conditional Repayment Lawsuit Not Time-Barred By 3-Year Claims Filing Provision

Conditional Payments, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on February 27, 2020
Posted by Jean S. Goldstein, JD, CMSP

The Eleventh Circuit recently opined that the 3-years claims filing provision found within the Medicare Secondary Payer Act does not apply to a Medicare Advantage Organization (MAO) when filing suit.  The Eleventh Circuit case was initiated by Plaintiff, MSPA Claims, which is a familiar entity in the Medicare Secondary Payer (MSP) litigation space.  As with […] Continue

CMS Hosts Townhall Meeting to Address MSP Recovery Topics and Statute of Limitations

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare Set-Aside Blog on January 21, 2020
Posted by Jean S. Goldstein, JD, CMSP

Last week, on January 14th, the Centers for Medicare & Medicaid Services hosted a townhall meeting, complete with a slide presentation to discuss several Medicare Secondary Payer Recovery topics.  During the townhall meeting, CMS discussed the conditional payment recovery process along with providing time at the end of the presentation for questions.  The slides from […] Continue

Warning: Another Law Firm Reprimanded for Failing to Repay Medicare Conditional Payments

Compliance, Conditional Payments, Medicare Set-Aside Blog, MSP News on January 9, 2020
Posted by Jean S. Goldstein, JD, CMSP

Yesterday, the U.S. Department of Justice’s Attorney’s Office for the Eastern District of Pennsylvania issued a press release stating that another Philadelphia-based personal injury law firm, has entered into a settlement agreement with the United States to resolve allegations that it failed to reimburse Medicare Conditional Payments.  You may recall we saw a similar action […] Continue