The Official Medicare Set Aside Blog And Information Resource

Respondent’s Brief in Opposition to the Caldera Cert Petition Filed

Medicare Set-Aside Blog, MSP Litigation on September 12, 2013 | Posted by Jennifer Jordan, JD, MSCC

On September 11, 2013, The Insurance Company of the State of Pennsylvania responded to Guadalupe Caldera’s appeal to the Supreme Court. In the 42 page brief, respondent provides several “Reasons to Deny the Writ,” none of which are terribly substantive. Respondent begins by attacking the language of the petition itself. The question presented by Caldera [...] Continue

Haro Injunction Lifted – CMS May Resume Referring MSP Debt to Collections During Appeals

CMS, Medicare Set-Aside Blog, MSP Litigation on September 5, 2013 | Posted by Jennifer Jordan, JD, MSCC

On September 4, 2013, the Ninth Circuit Court of Appeals issued an opinion overturning the 2009 injunction imposed by the Arizona District Court in Haro et al. v. Sebelius prohibiting CMS from placing MSP reimbursement efforts into collections while appeal and waiver requests were pending. The case, filed on behalf of three named Medicare beneficiaries, [...] Continue

Caldera Petitions Supreme Court for Cert

Medicare Set-Aside Blog, MSP Litigation on August 16, 2013 | Posted by Jennifer Jordan, JD, MSCC

On August 8, 2013, petition for certiorari was filed with the United States Supreme Court in the case of Caldera v. The Insurance Company of the State of Pennsylvania. The case ultimately represents the battle between state workers’ compensation laws and the federal Medicare Secondary Payer Act. In practice, CMS has routinely refused to acknowledge [...] Continue

CMS Issues Alert Regarding New Excluded ICD-9-CM Diagnosis Codes for No-Fault Claim Records

CMS, Medicare Set-Aside Blog, MSP News on August 16, 2013 | Posted by Jean S. Goldstein, JD

On August 15, 2013, CMS issued a technical alert for new excluded ICD-9 CM Diagnosis Codes for No-Fault Claim Records. Within the alert, CMS identified ICD-9 CM Diagnosis Codes that will no longer be accepted when submitting a no-fault claim record. Records that are submitted with one of the no longer accepted codes in the [...] Continue

CMS Regional Office Contacts

CMS, Medicare Set-Aside Blog on August 14, 2013 | Posted by Jean S. Goldstein, JD

A revised CMS Regional Office contacts document was posted on the WCMSA Submission page in the Workers’ Compensation Medicare Set-Aside Arrangements section. This updated document has been forthcoming for several months, as there have been several changes in personnel at some of the CMS regional offices. The link here will take you directly to that [...] Continue

More than a feeling…

Commentary, Medicare Set-Aside Blog, News and Events on August 1, 2013 | Posted by Jennifer Jordan, JD, MSCC

  Often when reviewing medicals for an MSA, we feel there is just no way these claimants are using the drugs indicated by the file. Yes, the physician did write the script, and yes, the carrier did pay for it, but something still just doesn’t add up. Well, it seems maybe there is some merit [...] Continue

Eleventh Circuit Court of Appeals Affirms Stricker

Medicare Set-Aside Blog, MSP Litigation, MSP News on July 29, 2013 | Posted by Jennifer Jordan, JD, MSCC

In an unsurprising decision over a year in the making, on July 26, 2013, the US Court of Appeals for the Eleventh Circuit affirmed the district court opinion in US v. Stricker et al. dismissing the US’ suit against pharmaceutical companies, their insurers and the attorneys representing the plaintiffs in a 2003 toxic tort settlement [...] Continue

Career opportunity with WCRC

Medicare Set-Aside Blog, News and Events on July 29, 2013 | Posted by Ryan Roth

Position: Workers’ Compensation Case Manager – Level II Review Provider Resources, Inc. (PRI) is the new Workers’ Compensation Review Contractor (WCRC) for the Centers for Medicare and Medicaid Services (CMS) and is seeking exceptionally talented and innovative Healthcare Professionals to support this program. PRI is now pursuing to hire individuals that have national reputations in [...] Continue

Humana Testing the National Waters for MAO Recoveries

Commentary, Medicare Set-Aside Blog, MSP Litigation on July 24, 2013 | Posted by Jennifer Jordan, JD, MSCC

As the great debate over what recovery rights Medicare Advantage Plans possess continues, it appears that Humana is attempting to parlay its 3rd Circuit win in In re Avandia into a national standard. In July 2013, Humana and one of its holdings, Cariten Health Plan, filed four lawsuits throughout the United States against Farmers and [...] Continue

Allocating for Botulinum Toxin Injections

Medicare Set-Aside Blog, Medicare Set-Asides on June 26, 2013 | Posted by Marilyn Larrimer, JD, RN

Botulinum toxins are neuromuscular blocking agents that are prescribed and administered by physicians for a variety of spastic disorders and excessive muscle contractions. Botulinum toxins aid in the treatment of overactive skeletal muscles, smooth muscles and glands. Currently, in the United States, the available botulinum products are: Botox®, Myobloc®, Dysport® and Xeomin®. While similar in [...] Continue