California

New Ruling: Court Expands upon Its Recent Ruling Limiting CMS Recovery Rights

The court in CIGA v. Price , 2017 WL 1737717 (C.D. California, May 3, 2017) has expanded upon its prior order limiting Medicare’s conditional payment rights. The case has garnered much industry...

Breaking: CMS Recovery Practice Ruled Improper under the MSP

In an important new case— CIGA v. Burwell , 2017 WL 58821 (C.D. California, January 5, 2017)—the court ruled that the CMS practice of seeking full reimbursement of a medical provider’s single...

Settlement Language Strikes Again New Case Proves Clear Provisions Are Critical

Settlement language is an important aspect of Medicare Secondary Payer (MSP) claims that demands careful consideration. When settlements fail to address key MSP issues or neglect to reflect payer...

California becomes fifth state to require closed drug formulary for workers' compensation claims

California Governor Jerry Brown has signed Assembly Bill No. 1124 , which mandates that the Division of Workers’ Compensation (DWC) implement a prescription drug formulary by July 1, 2017. The bill...

Impact of Utilization Review on Medicare Set-Asides

Although Utilization Reviews (URs) and Independent Medical Reviews (IMRs) have been used in state jurisdictions for years, insurers have only recently focused on how the Centers for Medicare and...