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
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
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
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
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
The concept of reversions is a topic that surfaces frequently in our structured settlement department. These clauses can seem confusing, sometimes made more complicated by uncertain futures; however, they are actually straightforward with tangible benefits associated with them. There are two primary questions we hear the most when clients are asking how they can recover […] Continue
On Wednesday, in the second decision of its kind this month, the United States District Court, Southern District of Florida denied in part and granted in part a Motion to Dismiss in a Medicare Advantage Organization (MAO) Medicare Secondary Payer Act (MSPA) recovery claim. MSPA Claims 1, LLC, et al. v. Century Surety Company, No. […] Continue
CMS posted a notification on their website that they will begin to utilize the CDC’s Table 1: Life Table for the total population: United States, 2012 on April 1, 2017. This means that for any WCMSA proposal received by CMS, or where any WCMSA case is reopened on or after April 1, 2017 CMS will apply […] Continue
In September 2016, House Representative Bill 6120 known as the Secondary Payer Advancement, Reconciliation, and Clarification (SPARC) Act was first introduced to Congress. The bill did not pass at that time, but was just recently reintroduced into the House of Representatives as HR 1122. Text of the recent bill is not yet available. The bill […] Continue
CMS just issued an additional amendment to the RFP for the WCMSA review contractor. The amendment published additional responses to questions by offerors, and also a change in the due date for proposals to 10:00 am February 15, 2017. The amendment to the solicitation can be found here. Stay tuned for more details. Continue