Settlement

11/15/2019 - 4 min read

All-or-nothing automation? Incremental change is a winning proposition

Robotic process automation (RPA), machine learning, and AI can be embedded in processes throughout the claim life cycle—from triaging through settlement.

11/8/2019 - 4 min read

CMS holds webinar on WCMSA Electronic Attestations for Professional Administration

On 11/6/19, CMS held a webinar on Workers’ Compensation Medicare Set-Aside (WCMSA) Electronic Attestation Enhancement for Professional Administrators.

10/31/2019 - 6 min read

CMS releases new WCMSA Reference Guide (Version 3.0)

CMS has released a revised Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide (Version 3.0, October 10, 2019).

10/18/2019 - 3 min read

CMS releases WCMSA Self-Administration Toolkit 1.3

CMS has released the latest edition of its Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (Version 1.3; October 10, 2019).

10/11/2019 - 8 min read

Ninth Circuit: CIGA is not a “primary payer” under the MSP and does not have to reimburse Medicare

In a significant new case out of California, the United States Circuit Court of Appeals (Ninth Circuit)[1] in California Insurance Guarantee Association (CIGA) v. Azar, 2019 WL 5076945 (9th Cir. Oct. 10, 2019) reversed the United States District Court for the Central District Court of California [2] and ruled that CIGA is not a “primary plan” under the Medicare Secondary Payer (MSP) statute and, therefore, not liable to reimburse Medicare conditional payments made on behalf of workers’ compensation claimants.

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10/3/2019 - 9 min read

South Carolina court: Medicare Advantage Plan can sue for “double damages” under the Medicare Secondary Payer statute

The South Carolina District Court is the latest jurisdiction presented with the question of whether a Medicare Advantage Plan (MAP) can sue for “double damages” under the Medicare Secondary Payer’s (MSP’s) private cause of action (PCA) statute.

8/21/2019 - 6 min read

Seventh Circuit bypasses Medicare Advantage “double damages” question

The Seventh Circuit affirmed (with modification) a ruling from the U.S. District Court for the Central District of Illinois dismissing a MAP assignee’s PCA claim on standing grounds.

7/26/2019 - 9 min read

Massachusetts court: Medicare Advantage Plan’s assignee can sue for “double damages” under the MSP

Massachusetts is the latest jurisdiction to take a favorable view of MAPs possessing private cause of action rights under the Medicare Secondary Payer.

7/11/2019 - 2 min read

PAID Act introduced in the U.S. Senate

On June 26, 2019, Senators Tim Scott (R-SC) and Ben Cardin (D-MD) introduced Senate Bill 1989 into the U.S. Senate.

7/8/2019 - 8 min read

Medicaid expansion makes recovery efforts more urgent

Within broad federal requirements, states and territories have significant flexibility in program design and administration, resulting in 56 unique Medicaid programs.

6/17/2019 - 8 min read

Florida court: No-fault pre-suit notice requirement must be followed before Medicare private cause of action claim can proceed

In a new Florida decision, the U.S. District Court in ruled Florida’s no-fault pre-suit notice requirement must be satisfied before a PCA action can proceed.

5/16/2019 - 8 min read

Reality check: Debunking the myths of Medicare Secondary Payer compliance

MSP is a challenging area of compliance for which federal law, regulations, and policy don’t always provide clear answers. It’s vital to understand fact vs fiction.

4/24/2019 - 7 min read

Longshore Act - Medicare alert: Court rules that claimant’s action for “double damages” was premature

Claims payers pursuant to the Longshore Act need to stay vigilant for potential double damages actions under the MSP statute’s private cause of action provision

3/21/2019 - 4 min read

Maryland law firm reaches $250,000 settlement with U.S. Department of Justice to reimburse Medicare conditional payments

A Maryland personal injury law firm settled for $250,000 with the U.S. to resolve allegations it failed to reimburse certain Medicare payments made to medical providers on behalf of a firm client.

12/21/2018 - 2 min read

Proposed rules for addressing future medical obligations to be released

The Office of Information and Regulatory Affairs (OIRA) recently issued a notice entitled Miscellaneous Medicare Secondary Payer Clarifications and Updates (CMS-6047-P). This notice indicates that the Centers for Medicare and Medicaid Services (CMS) plans on issuing proposed rules regarding options to address future medicals in relation to liability, workers’ compensation and no-fault cases.