The Official Medicare Set Aside Blog And Information Resource

U.S. Attorney’s Office Settles Conditional Payments Debts with Personal Injury Law Firm and Requires Attorney to Institute Best Internal Compliance Practices

Conditional Payments, Medicare, MSP News on June 20, 2018
Posted by Jean S. Goldstein, JD

On Monday, the U.S. Department of Justice’s Attorney’s Office for the Eastern District of Pennsylvania issued a press release concerning a settlement arrangement involving the repayment of conditional payments.  U.S. Attorney William M. McSwain announced that the Philadelphia personal injury law firm, Rosenbaum & Associates, and its principal, Jeffrey Rosenbaum entered into a settlement agreement […] Continue

2018 Social Security and Medicare Trustees’ Report Issued; Warn of Depletion of Trust Funds

Medicare, Medicare Set-Aside Blog, MSP News, Social Security on June 7, 2018
Posted by Jean S. Goldstein, JD

Each year, the board of trustees of the Social Security Trust Fund and Medicare Trust Fund release reports to Congress providing an estimated projected financial outlook for the programs. This week both reports were released.  The 77th annual Social Security Report can be found here, and the 53rd annual Medicare report can be found here.  […] Continue

H.R.5881 Introduced in An Effort to Add Transparency to MSP Reporting Information

CMS, Medicaid, Medicare, Medicare Advantage, Medicare Set-Aside Blog, MSP News on May 22, 2018
Posted by Jean S. Goldstein, JD

Last week, Congressman Gus Bilirakis and Congressman Ron Kind introduced legislation (H.R. 5881) in the House of Representatives to amend title XVIII of the Social Security Act, specifically in an effort to provide for transparency of Medicare Secondary Payer (MSP) reporting information.  Congressman Bilirakis issued a press release yesterday stating that, “[t]his legislation will ensure […] Continue

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