The Official Medicare Set Aside Blog And Information Resource

Did the United States Court of Appeals for the Sixth Circuit Just Pave the Way for More MSP Private Causes of Action?

Medicare Set-Aside Blog, MSP Litigation, MSP News on April 18, 2018 | Posted by Jean S. Goldstein, JD

In today’s day and age of conditional payment recoveries, whenever a settlement of a claim is imminent, parties begin to worry about what possible challenges may impede the settlement, or even arise after settlement.  Yesterday, an interesting case from the United States Court of Appeals for the Sixth Circuit was issued; and while the fact […] Continue

CMS Posts Update of Medicare Part D Opioid Prescribing Mapping Tool

CMS, Medicare Set-Aside Blog, Opioids on April 17, 2018 | Posted by Jean S. Goldstein, JD

The Centers for Medicare & Medicaid Services (CMS) released an updated version of the Medicare Part D opioid prescribing mapping tool, providing an interactive, web-based resource that presents geographic comparisons- at the state, county, and ZIP code levels – of Medicare Part D opioid prescribing rates.  The tool allows users to understand and compare opioid […] Continue

CMS Issues Updates for Medicare Advantage and Prescription Drug Benefit Program: Will it Affect Your WCMSA?

CMS, Medicare Advantage, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Opioids on April 5, 2018 | Posted by Jean S. Goldstein, JD

Earlier this week, CMS issued a policy change revising the Medicare Advantage Program (MAP) Part C regulations and Prescription Drug Benefit program (Part D).  The ultimate goal of the new policy is to ensure that individual’s treatment needs are met, while improving the quality of care and providing greater choices to MA enrollees.  The full […] Continue

CMS Increased Conditional Payment Demand by $142k: New York Supreme Court Vacates Settlement Agreement

CMS, Conditional Payments, Medicare Set-Aside Blog, MSP Litigation on March 26, 2018 | Posted by Jean S. Goldstein, JD

An interesting case came out of the Supreme Court of New York City on Friday, challenging whether a settlement agreement may be declared null and void based upon an erroneous assumption of the total sum of conditional payments made by Medicare.  Mayo v. NYU Langone Med. Ctr., 2018 NY Slip Op 30456(U) (Sup. Ct.). The parties litigated […] Continue

11th Circuit Finds MAOs May Bring Double Damages Private Cause of Action Against Medical Providers

CMS, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on March 21, 2018 | Posted by Jean S. Goldstein, JD

The 11th Circuit issued an opinion yesterday on a Motion to Dismiss on a claim addressing a new question, one they have never been faced with before: Whether an MAO has a private cause of action against the recipient, or a provider of a primary payment. Claims v. Bayfront Hma Med. Ctr., 2018 U.S. Dist. […] Continue

Updated WCMSA Reference Guide Issued

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, WCRC on March 21, 2018 | Posted by Jean S. Goldstein, JD

An updated Workers’ Compensation Medicare Set-Aside (WCMSA) reference guide has been issued.  The revised guide, version 2.7, can be found here. The revised WCMSA reference guide has two minor updates, which are: An updated phone number for the new Workers’ Compensation Review Contractor “WCRC” (1-833-295-3773 between 9am-5pm EST, Monday thru Friday); and A revised Confidentiality […] Continue

New CRC Contractor: What Are Our First Impressions?

Conditional Payments, CRC, Medicare Set-Aside Blog, MSP News, WCRC on March 20, 2018 | Posted by Jean S. Goldstein, JD

It’s been over a month since the anticipated transition of the Commercial Repayment Center (CRC) contractor from CGI Federal to Performant Recovery.  Our first impressions have all been positive.  As with all transitions to new government contractors, we of course had some reservations and concerns, but to date are encountering only positive experiences. Some quick […] Continue

Second Circuit Court Addresses Whether An MAO May Bring Suit: Primary Payer Takes the Hit

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on March 15, 2018 | Posted by Jean S. Goldstein, JD

Nearly every week those of us in the Medicare Secondary Payer (MSP) industry receive alerts about a new Medicare Advantage Organization (MAO) bringing suit for failure to provide reimbursement for conditional payments made by an MAO on behalf of a Medicare beneficiary.  Many of these suits come out of the Third and Eleventh Circuits, and […] Continue

WCRC Transition to be Seamless and Promising

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on March 7, 2018 | Posted by Jean S. Goldstein, JD

CMS and Capitol Bridge LLC, the entity taking over as the new Workers’ Compensation Review Contractor (WCRC) held a webinar today regarding the planned WCRC transition.  CMS introduced Capitol Bridge, who categorically addressed concerns regarding the transition.  It was quite clearly stated that today’s webinar would not address any policy questions, but simply address transition […] Continue

Capitol Bridge WCRC Transition Planned for 03/19/18

CMS, CRC, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on March 1, 2018 | Posted by Jessica M. Wingenroth, JD

CMS has invited the industry to participate in a Transition Webinar on 03/07/18 at 1:00 PM ET to discuss the transition of the Workers’ Compensation Review Contractor (WCRC) from Provider Resources, Inc. to Capitol Bridge, LLC. Capitol Bridge will assume responsibility of the WCRC contract on 03/19/18. As you may recall from our prior reports, […] Continue

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