Category Archives: Medicare Jurisdiction

Blog, Medicare Conditional Payments, Medicare Jurisdiction

As required by section 202 of The SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts. For the last two years 2017-2018, CMS has maintained the threshold of $750 across all non-group health plan (NGHP) lines of business- workers’ compensation, liability, and no-fault insurance. The threshold means that if …
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Blog, Medicare Jurisdiction, Medicare Set Aside

As of October 1, 2018, both the Non-Group Health Plan (NGHP) User Guide and Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide have been updated with minor changes. The updated NGHP User Guide can be found here and the updated WCMSA Reference Guide can be found here. Below are summaries of the changes in both of the Guides: NGHP User Guide: …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Jurisdiction, Medicare Secondary Payer News

Reprinted from the Morning Consultant In health policy, the minutia is not trivial; it’s essential. Small incentives created by policymakers can have a significant impact upon how Medicare beneficiaries, doctors, hospitals and insurers respond to health care claims. But sometimes policies — even the most well-intentioned — can have unintended consequences, leading to wasted resources, burdensome regulations and broken promises …
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Blog, Medicare Jurisdiction, Medicare Secondary Payer News, WCMSA

The Centers for Medicare & Medicaid Services (CMS) issued an updated Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide on July 31st, although the Reference Guide is dated July 10, 2017. There are several important changes to note within this new Reference Guide (the new Guide can be located here). We have listed the more noteworthy changes first: Updated Amended Review …
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Legal/Legislative News, Medicare Jurisdiction, Medicare Set Aside, WCMSA

There are two recent updates which may impact workers’ compensation payers looking to finalize and foreclose future medical expenses and which additionally may impact claims that involve a Medicare Set-Aside (MSA). I. Arizona Passes Bill 1332 Allowing for Full and Final Settlement of Workers’ Compensation Claims Senate Bill 1332, signed into law by Governor Ducey on May 8, 2017 which …
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Blog, Medicare Jurisdiction, Medicare Set Aside, WCMSA

The Centers for Medicare & Medicaid Services (CMS) has followed through on their previously announced intent to expand their Medicare Set-Aside (MSA) Re-Review process. For our prior blog on CMS’ January announcement that it intended to expand its re-review process in 2017, click here. For those that need a refresher on CMS’ MSA Re-Review process, where an MSA is submitted …
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Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Secondary Payer News

During an interview on this past Sunday, President Trump indicated that he does not plan to touch the concept of Medicare; however, he and his administration would be tough on Medicare fraud, waste, and abuse. The timing of this statement by President Trump is coincidental with the United States joining in on a False Claims Act (FCA) whistleblower lawsuit this …
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Blog, Legal/Legislative News, Medicaid Third Party Liability Recoveries, Medicare Jurisdiction, Medicare Secondary Payer News, Medicare Set Aside

A Complaint has been filed in the State of Utah by its Attorney General to force four of its largest asbestos bankruptcy trusts to comply with civil investigative demands (CIDs) seeking information regarding whether the trusts were failing to reimburse Medicare and Medicaid for medical expenditures. The Complaint was filed March 7th in Salt Lake City. A copy of the …
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Medicare Secondary Payer False Claims Act Update

23 Jan 2017 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Secondary Payer News

Lately, we have seen an increase in Medicare Secondary Payer (MSP) False Claims Act (FCA) litigation in Federal courts. Below is an update on two prior existing MSP FCA cases- U.S. ex rel. Kent Takemoto (U.S. Court of Appeals, 2nd Circuit), and Negron v. Progressive (U.S. District Court, New Jersey). Additionally, we have become aware of the now unsealed MSP …
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Blog, Medicare Jurisdiction, Medicare Reporting Section 111

On the heels of CMS’ announcement from May 2016 that it was taking steps to comply with the Medicare Access and CHIP Reauthorization Act (MACRA), which requires CMS to remove SSNs from Medicare ID cards by April 16, 2019, CMS has announced an Open Door Forum call to address how this change would impact Section 111 processes. More information on …
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