Hear what our attorneys are saying

16
Jul 2019

Updated Status of Commission Rules Concerning EOBs

By Amy Bilton and James A. Moran     

  Our office recently received several questions regarding the proposed Explanation of Benefits (“EOB”), as well as the current Department of Insurance Rules concerning electronic billing in Workers’ Compensation claims.  Amy Bilton, a co-author of this blog post, serves on the Illinois Workers’ Compensation Medical Fee Advisory Board, and was part of the task force
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16
Jul 2019

MSP Case Law Update

By Joseph Gregorio     

  Auto Carrier’s “Legitimate Defense” Sufficient to Convince Medicare, and Protect Against Double Damages When Proven Wrong In Duncan v. Liberty Mutual Insurance Company, 2019 U.S. Dis. LEXIS 106265, the U.S. District Court for the Eastern District of Michigan found that a decedent’s Estate (“Plaintiff”) did not have standing to seek double damages against Liberty
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16
Jul 2019

Staying In Your Lane: Navigating the Ethics of Medicare Set-Asides

By Julie A. Garrison     

  Medicare Secondary Payer (MSP) compliance is a detailed, somewhat complicated, and often dynamic field. MSP law and regulations are constantly evolving and subject to some interpretation. MSP consultants contend with claims and risk management concerns, medical and health sectors, legal and privacy issues, and both federal and state government agencies. Various professionals with overlapping
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16
Jul 2019

Medicare Part D Coverage for Opioids and the MSA

By Rasa Fumagalli     

  A Medicare Set-Aside (MSA) is a settlement tool used by parties to prevent a cost shift of future injury-related Medicare covered expenses to Medicare when the settlement terms close out liability for future medical. The MSA will generally include projections for future injury-related medical treatment and prescription drugs that are covered by Medicare. Since
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11
Jun 2019

Viable Fraud Claims in Workers’ Compensation Claims

By Adam Cox     

  Section 25.5 of the Illinois Workers’ Compensation Act (820 ILCS 305/25.5) governs workers’ compensation fraud in Illinois.  It sets forth nine specific circumstances in which any person, company, corporation, insurance carrier, healthcare provider, or any other entity could violate the law.  These include: making or presenting a false claim for benefits, any false or
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