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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The Grinding Gears of CMS Regulation

27 Jun 2017 John Williams No Comments

Blog, Franco Signor News, Legal/Legislative News, Medicare Conditional Payments, Medicare Reporting Section 111, Medicare Secondary Payer News, Medicare Set Aside

The Grinding Gears of CMS Regulation A CLM Magazine Article by John Williams and Heather Sanderson Personal Injury and No-Fault Payers Should be Aware of Three Compliance Issues  As the Centers for Medicare and Medicaid Services (CMS) faces mounting pressure to address financial challenges, the agency is looking for methods to recover over-payments and ensure that it does not make a …
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Blog, Legal/Legislative News, Medicare Reporting Section 111

In a decision out of the Superior Court of Connecticut, Silver v. Miliford Medical Center Associates, 2017 Conn. Super. LEXIS 899 (May 11, 2017), a defendant medical provider filed a motion to compel the Plaintiff to respond to supplemental discovery so that its insurer could comply with the requisite requirements of MMSEA Section 111. Essentially, the medical provider’s insurer, which …
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About Franco Signor, Franco Signor News, Medicaid Third Party Liability Recoveries, Medicare Secondary Payer News

Medicare Advantage Plans, LMSA/NFMSAs, and Medicaid Recovery Rights: What’s on the Horizon?  Medicare Advantage plans are continuing to litigate nationwide to assert their rights to double damages for unreimbursed conditional payments. Class actions are being certified by MAOs to assert these rights against primary payers. CMS is taking steps announced plans toward establishing a voluntary review process for LMSAs and …
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Blog, Medicare Conditional Payments, Medicare Secondary Payer News, Reimbursements

The California Insurance Guaranty Association (CIGA) is California’s largest workers’ compensation provider as the insurer of last resort for employers who would otherwise not be able to afford the mandatory coverage.  Because it operates for all intents and purposes as an adverse risk pool, it must exercise care in payments it makes for worker’s compensation claims that result.  Consequently, when …
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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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