The Official Medicare Set Aside Blog And Information Resource

THE UR/IMR PROCESS: STILL GOOD ON ITS FACE.

CMS, Independent Medical Review, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Work Comp on June 21, 2017 | Posted by Jean S. Goldstein, JD

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

FDA Requests Endo Pharmaceuticals Withdraw Opana ER From the Market

FDA, Medicare Set-Aside Blog, Opioid, Opioids on June 9, 2017 | Posted by Erin O'Neill, PA-C, JD

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

Countdown to October – Are You Ready for LMSAs and NFMSAs?   

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on June 5, 2017 | Posted by Jennifer Alvarez, JD, RN, MSCC, CMSP

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

New Medicare Cards to Feature New Identifiers

CMS, Medicare Set-Aside Blog, MSP News, Social Security on May 31, 2017 | Posted by Jean S. Goldstein, JD

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

CIGA Entitled to Judicial Declaration of Unlawful CMS Interpretation of the MSP

CMS, Medicare Set-Aside Blog, MSP Litigation on May 4, 2017 | Posted by Jennifer Jordan, JD, MSCC

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

HHS Grants to Fight Opioid Addiction: How Could the Grants Impact Your MSA?

CMS, Medicare Set-Aside Blog, Opioids, Rx/Pharmacy on May 4, 2017 | Posted by Jean S. Goldstein, JD

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

Evidence of Medicare Advantage Organization Not Acting in Medicare’s Best Interests

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on May 3, 2017 | Posted by Jennifer Jordan, JD, MSCC

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

MEDVAL BLOG: AWARDED ONE OF THE BEST BLOGS IN THE INDUSTRY

Medicare Set-Aside Blog, MEDVAL News, News and Events on May 3, 2017 | Posted by Jean S. Goldstein, JD

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

$40 Million Dollars Paid by Insurance Carriers and 13,000 California Patients Affected in an Alarming Kickback Scheme

Fraud, Medicare Set-Aside Blog, Work Comp on April 21, 2017 | Posted by Jean S. Goldstein, JD

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

Arkansas Act 1058: What About a Carrier’s Obligations Under the Medicare Secondary Payer Act?

Medicare Set-Aside Blog, MSP News, State Regulations on April 19, 2017 | Posted by Jean S. Goldstein, JD

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