The Official Medicare Set Aside Blog And Information Resource

CMS Adds a Proposed Rule – Will it Affect Your Workers’ Compensation and Liability Claims?

CMS, Medicare Set-Asides, MSP News on December 10, 2018
Posted by Jean S. Goldstein, JD

The Centers for Medicare & Medicaid Services (CMS) recently added an item to the Unified Agenda, which may have an impact on your claims.  The Unified Agenda of Federal Regulatory and Deregulatory actions is a semiannual compilation of information about regulations under development by federal agencies published in the spring and fall.  The item added […] Continue

FDA Awards Six-Month Patent Extension for Lyrica

FDA, MSP News, Rx/Pharmacy on November 30, 2018
Posted by Complex Claims Division

You may recall our earlier blog this week about Lyrica in the News.  Once again, the spotlight is on Lyrica.  First, after Pfizer was awarded a six-month patent extension based on a new pediatric indication for the drug.  Earlier this month, the Supreme Court in the United Kingdom ruled against Pfizer in a longstanding patent […] Continue

Lyrica In the News

CMS, MSP News, Rx/Pharmacy on November 26, 2018
Posted by Complex Claims Division

Lyrica and its manufacturer Pfizer have been in the news quite frequently this month, and the publicity has not been positive.  Most recently, on November 14th, the Supreme Court of the United Kingdom (U.K.) ruled against Pfizer in a patent infringement lawsuit that has spanned the past several years. It’s no secret that pharmaceutical manufacturers […] Continue

CMS Will Maintain $750 Recovery Threshold for 2019

CMS, Conditional Payments, Mandatory Insurer Reporting on November 21, 2018
Posted by Jean S. Goldstein, JD

The Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act) requires the Centers for Medicare & Medicaid Services (CMS) to publish an annual threshold for recovery in November, each year.  This threshold amount reflects an amount for which CMS will not spend more on collections than a claim is likely to yield.  In […] Continue

FDA Issues Safety Communication Regarding Medications Utilized in Intrathecal Pumps

FDA, MSP News, Rx/Pharmacy on November 20, 2018
Posted by Erin O'Neill, PA-C, JD

On November 14, 2018, the Food and Drug Administration (FDA) issued a safety communication to all patients with implanted intrathecal pumps, their caregivers and health care providers, and medication compounding companies warning of the dangers of utilizing medications in intrathecal pumps that have not specifically been approved for intrathecal pump use. Intrathecal pumps are programmable devices that […] Continue

Medicare Secondary Payment Recovery Portal (MSPRP) to Allow for Self-Reporting: Coming January, 2019

CMS, Medicare Secondary Payer Recovery Portal, MSP News on November 19, 2018
Posted by Jean S. Goldstein, JD

You may recall that several months ago, CMS held an informative webinar regarding the benefits of using the Medicare Secondary Payment Recovery Portal (MSPRP). During this webinar, CMS also announced several future enhancements coming to the MSPRP.  One of the upcoming enhancements is the ability to self-report.  CMS announced today that effective January 7, 2019, authorized […] Continue

Medicare’s Conditional Payment Recovery Process is Ramping Up:  What You Need to Know.

Conditional Payments, CRC, MSP News on November 14, 2018
Posted by Jean S. Goldstein, JD

Last month, at the annual National Alliance of Medicare Set-Aside Professionals’ Annual Conference, Performant Financial (Performant), the current contractor for the Commercial Repayment Center (CRC), held a timely panel question and answer session.  You may recall that we recently blogged about how the current conditional payment recovery process continued to terrorize many non-group health plans.  […] Continue

The Opioid Crisis: What is the Government Doing About It? Part 3 – The Promotion of Healthy, Evidence-Based Methods of Pain Management

Medicare Set-Aside Blog, MSP News, Rx/Pharmacy on November 2, 2018
Posted by Complex Claims Division

This blog series is devoted to better understanding the efforts our Federal government is undertaking to combat the opioid epidemic in America. Earlier this year, the Department of Health and Human Services (HHS) announced a five-part strategy that will be utilized to combat the opioid epidemic. In previous posts, we have focused on parts one […] Continue

Structured Settlements in the Field

CMS, Medicare Set-Asides, Structured Settlements on October 24, 2018
Posted by Katharine Rupp, JD

In our last blog about structured settlements we reviewed the basics of what a structured settlement is and why you would want to structure a settlement. However, the benefits of structuring a settlement are best shown through real life examples. Below are three scenarios in which MEDVAL was able to provide creative settlement solutions utilizing […] Continue

As MAPs Continue Recovery Efforts, Florida Court Says the MSP Does Not Preempt State Law

Medicare Advantage, MSP Litigation, MSP News on October 16, 2018
Posted by Jean S. Goldstein, JD

You may recall that we recently blogged about whether the Medicare Secondary Payer (MSP) Act, a Federal law, preempts State law.  A Maryland case quite succinctly addressed this question several months ago finding that State law is not preempted by the MSP if certain conditions are met.  This question was also addressed recently in a […] Continue