Hear what our attorneys are saying

31
Jul 2018

Crossing the Threshold: What’s included in the Total Settlement Amount?

By Julie A. Garrison     

  CMS will consider a proposed Medicare Set-Aside (MSA) when the Total Settlement Amount (TSA) exceeds the one of two review thresholds. The CMS review thresholds are well-known and, for Medicare beneficiaries, is only $25,000. For claimants who have a reasonable expectation of Medicare enrollment within 30 months of the settlement date, the threshold jumps
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31
Jul 2018

The Private Cause of Action under the Medicare Secondary Payer Act

By Vinal Patel     

  The Medicare Secondary Payer (MSP) Act provides that Medicare will make conditional payments for medical services when a primary plan has not made, or cannot reasonably be expected to make, payments for those services. 42 USC §1395(y)(b)(2)(B)(i). If it turns out that the “primary payer” had a responsibility to make those payments, Medicare is
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31
Jul 2018

The Lumbar MRI Dilemma

By Lisa Azoory-Keller     

  If you’ve got low back pain, you’re in good company.  Low back pain is the most common musculoskeletal condition in the adult population, with prevalence up to 84%.[1]  The use of advanced imaging (such as MRI) is dramatically on the rise, despite lack of evidence to support its benefit.[2] The fact pattern may be
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24
Jul 2018

Dispelling MSP Compliance Myths

By Rasa Fumagalli     

  By now, most claims adjusters and attorneys involved in workers’ compensation and liability settlements are aware of the Medicare Secondary Payer Act (MSP Act) and the potential impact that it may have in certain settlements. An incomplete understanding of the actual obligations however may result in a less than ideal approach for claims handling
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12
Jun 2018

Caution: MSP Caselaw Ahead

By Linda Meccia     

Please review the latest Caselaw pertaining to the MSP Act. MSP Caselaw Ahead 061118  

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