The Official Medicare Set Aside Blog And Information Resource

CMS’ Fraud Prevention System Creates Significant Impact

Fraud, Medicare, Medicare Set-Asides on July 29, 2015 | Posted by Jennifer Alvarez, JD, RN, MSCC, CMSP

The Centers for Medicare & Medicaid Services (CMS) recently recognized and applauded the agency’s internal Fraud Prevention System for the identification or prevention of $820 million in improper payments during the program’s first three years of operation. The focus of the Fraud Prevention System is to help protect Medicare Trust Funds and prevent fraudulent payments […] Continue

Social Security and Medicare Boards of Trustees Call for Swift Action by Lawmakers in 2015

CMS, Medicare, Medicare Set-Aside Blog, Social Security on July 27, 2015 | Posted by Jessica M. Wingenroth, JD

Last week the Social Security and Medicare Boards of Trustees released their 2015 Annual Reports, recommending “prompt corrective action by lawmakers.” In their Message to the Public, the most urgent action was called for the Social Security Disability Insurance program, which has trust fund reserves that are expected to deplete in late 2016. A 2016 […] Continue

Avinza Extended-Release Capsules No Longer Being Manufactured

Medicare, Medicare Set-Asides, Rx/Pharmacy on July 22, 2015 | Posted by Erin O'Neill, PA-C, JD

The Food and Drug Administration (FDA) has announced that all strengths of Avinza (morphine sulfate) extended release capsules have been discontinued. Avinza is a Schedule II long acting opioid medication indicated for the treatment of severe pain only. Avinza carried a black box warning indicating that misuse could lead to death due to the lack […] Continue

Is Medicare Advantage Entitled To Bring A Private Cause Of Action Under The Medicare Secondary Payer Act?

CMS, Medicare, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on June 24, 2015 | Posted by Michele Zimmerman

This law review article by Jennifer Jordan, general counsel at MEDVAL, was recently published in the William Mitchell Law Review. It’s an in-depth analysis of the current state of Medicare Advantage recovery rights and provides a well-reasoned rationale as to whether or not MAOs were intended to share exactly the same recovery rights as traditional […] Continue

RAC Program Revisions Necessitate Appeals Process Review

Commentary, Medicare, Medicare Set-Aside Blog on April 21, 2015 | Posted by Gwendolyn Hauck

In 2013, almost $4 billion in improper Medicare payments were identified and returned.[1] This staggering number can be attributed to the work of the Recovery Audit Program. The Recovery Audit Program was initially authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 in an effort to facilitate cost-effective enforcement of the myriad […] Continue

Medicare Trust Fund Exhaustion Pushed Back Until 2030

Medicare on July 28, 2014 | Posted by Jennifer Jordan, JD, MSCC

In its Trustees Report released July 28, 2014, CMS announced that the Medicare trust fund will remain solvent until 2030, four more years than previously projected, due in part to cost controls implemented in the Affordable Care Act. Factors that contributed to the improved outlook included lower than expected spending in 2013 and decreased overall […] Continue

WC not Subject to MSP Private Cause of Action Under 42 UCS 1395y(b)(3)(A)?

Medicare, Medicare Set-Aside Blog, MSP Litigation on September 27, 2013 | Posted by Jennifer Jordan, JD, MSCC

Strict statutory construction strikes the MSP again. The US District Court for the Western District of Kentucky has interpreted the private cause of action provided under section 1395y(b)(3)(A) to only apply to group health plans. The case in question involved a death following a 2007 auto accident incurred during the course and scope of the […] Continue

Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2013

Commentary, Medicare, Medicare Set-Aside Blog on May 16, 2013 | Posted by Jennifer Jordan, JD, MSCC

On May 15, 2013, Congressmen Reichert and Thompson introduced H.R. 1982 into the House of Representatives. I have run a pdf comparison on this bill and H.R. 5284 and have found it to be substantially the same bill, making this the fourth try in consecutive Congresses with little track record of progress. Regardless of some […] Continue

10th Amendment Victory or Texas Justice?

CMS, Commentary, Medicare, Medicare Set-Aside Blog, MSP Litigation, Work Comp on May 15, 2013 | Posted by Jennifer Jordan, JD, MSCC

On May 14, 2013, the much awaited 5th Circuit appellate decision was filed in Caldera v. The Insurance Company of the State of Pennsylvania (ICPS), finding in favor of state workers’ compensation law over the Medicare Secondary Payer Act. As a reminder since it has been considerable time since the original decision, this case involved […] Continue