The Official Medicare Set Aside Blog And Information Resource

FDA Greenlights Marketing of First Blood Test Designed to Aid in Diagnosis and Evaluation of Concussions

CMS, Medicare, Medicare Set-Aside Blog, MSP News on February 15, 2018 | Posted by Erin O'Neill, PA-C, JD

On February 14, 2018, the Food and Drug Administration (FDA) announced authorization of marketing of the Banyan Brain Trauma Indicator, which is the first blood test of its kind designed to aid in the evaluation of mild traumatic brain injuries (concussions) in adults. The blood test is designed to detect the presence of two protein […] Continue

Sublocade – A New Once-Monthly Injection for the Treatment of Opioid Use Disorder

CMS, FDA, Medicare, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Opioids on February 5, 2018 | Posted by Katherine Bales, RN, JD

The opioid crisis continues to be one of the most talked about issues facing the health care community, and the nation as a whole, having been declared a national public health emergency. In response, pharmaceutical companies have been actively working on ways to treat the crisis with the development of alternative treatment methods. The FDA […] Continue

Full Medicaid Recovery Coming to a Claim Near You: October 1st

Conditional Payments, Medicaid, Medicare, Medicare Set-Aside Blog, MSP News on September 25, 2017 | Posted by Jean S. Goldstein, JD

As we have seen, Medicare Advantage Plans, Military/Governmental Healthcare Providers, and Private Insurers are aggressively pursuing liens with a priority right approach to recovery.  We often discuss these entities in the context of being a secondary payer, and the omnipresent concern that these entities will seek reimbursement of payments that have been conditionally made, when […] Continue

New WCMSA Reference Guide Issued

CMS, Medicare, Medicare Set-Asides, MSP News, Re-Review Process on August 1, 2017 | Posted by Jean S. Goldstein, JD

As you may be aware, on July 10th, here on our blog we announced the quiet release of a change to CMS’ re-review process.  However, as we noted at that time, this process was not formalized by CMS, and had simply been released through CMS’ Workers’ Compensation Medicare Set-Aside Portal (WCMSAP).  Specifically, through a revised WCMSAP User Guide, […] Continue

Medicare Trustees Announce Trust Fully Funded Through 2028

CMS, Medicare, News and Events on June 22, 2016 | Posted by Jennifer Jordan, JD, MSCC

CMS News FOR IMMEDIATE RELEASE June 22, 2016 Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries Medicare Trustees Report Shows Continued Slow Cost Growth Today, the Medicare Trustees projected that the trust fund financing Medicare’s hospital insurance coverage will remain fully funded until 2028, 11 years longer than they projected in 2009 before […] Continue

The MSP is not so “Extraordinary” that it Completely Preempts State Law

CMS, Commentary, Medicare, Medicare Set-Aside Blog, MSP Litigation on May 4, 2016 | Posted by Jennifer Jordan, JD, MSCC

Great MSP case reported out of Pennsylvania on May 3, 2016 involving what the MSP does not do, in particular, preempt state law under any circumstances. From the brief facts presented in the background,  it is clear that the parties arrived at a lump sum settlement agreement and that the insurer attempted to button up […] Continue

H.R. 2649 Update

CMS, Commentary, Medicare, Medicare Set-Aside Blog on March 14, 2016 | Posted by Jennifer Jordan, JD, MSCC

On March 7, 2016, H.R. 2649: Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2015 found itself a new co-sponsor. Representative John Larson of Connecticut joined the ranks of congressmen that now know what a Medicare set-aside is and don’t care that there is no legal requirement to participate in the voluntary CMS […] Continue

Medicare Recovers Despite Failure to Treat Being the Claim

CMS, Commentary, Liability, Medicare, Medicare Set-Aside Blog, MSP Litigation on March 4, 2016 | Posted by Jennifer Jordan, JD, MSCC

Alleging medical damages and receiving compensation for release from liability for those same medical damages will result in reimbursing Medicare for related medical expenses pretty much regardless of your legal theory as to why you should keep that windfall rather than the federal government. On March 3, 2016, the U.S. District Court for the Eastern […] Continue

NJ District Court Permits False Claims Act Suit Against Progressive to Continue

CMS, Commentary, Medicare, Medicare Set-Aside Blog, MSP Litigation on March 2, 2016 | Posted by Jennifer Jordan, JD, MSCC

On March 1, 2016, the U.S. District Court for the District of New Jersey denied a motion to dismiss in a False Claims Act (FCA) suit against Progressive Insurance, essentially granting standing to the relators. Case involves Progressive “health first” auto policies sold online in New Jersey that caused Medicare to be billed as primary […] Continue

CMS May Finally Be Forced to Address Medicare Appeal Backlog

CMS, Commentary, Medicare, Medicare Set-Aside Blog, MSP News on February 10, 2016 | Posted by Jennifer Jordan, JD, MSCC

On Tuesday, February 9, 2016, the U.S. Court of Appeals for the District of Columbia overturned the December 2014 dismissal of a suit by the American Hospital Association against DHHS for unreasonable delays in processing RAC appeals. At the time the lower court ruled that the delay wasn’t unreasonable enough to elicit an order from […] Continue