Hear what our attorneys are saying

11
Mar 2020

CMS Civil Monetary Penalties Rules Revealed: Time to Prepare (and to Wait)

By Paul Pasche     

  The Centers for Medicare and Medicaid Services (CMS) recently released its long-awaited proposed rule for imposition of mandatory civil penalties to enforce the Mandatory Insurer Reporting program commonly known as “Section 111 Reporting.” The comment period for the proposed rule runs until April 20, 2020, and we encourage all stakeholders to review the rule
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29
Jan 2020

Never Break the Chain: Chain of Referral Issues

By Nancy Wilensky     

  Medical bills often become an issue at the brink of a workers’ compensation trial or settlement.  On the doorsteps of closure, a new primary care physician, chiropractor or other provider may surface and present an obstacle to closing the claim.  What defenses does a respondent have?  The limitation on claimant’s choice of physicians under
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27
Jan 2020

Section 111 – Strategic Compliance Improves Outcomes

By Paul Pasche     

  By now, most of our readers are familiar with the Mandatory Insurer Reporting statute, commonly called “Section 111 Reporting,” because it originated in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007. As it applies to the insurance claims and defense industry, Section 111 mandates that insurers or self-insured entities, and
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27
Jan 2020

Avoiding Medicare Secondary Payer Compliance Settlement Term Traps

By Rasa Fumagalli     

  Medicare is a secondary payer when a primary payer is available and has a demonstrated responsibility to make payment. Under the Medicare Secondary Payer statute and regulations, a “primary plan’s responsibility for payments may be demonstrated by a judgment, a payment conditioned upon the recipient’s compromise, waiver of release (whether or not there is
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27
Jan 2020

Unintended Medicare Consequences from Workers’ Compensation Claim Handling

By William Delaney     

  Medicare exposure can be significantly impacted by claim decisions made early in the handling of a workers’ compensation case. Medicare is a secondary payer to an applicable workers’ compensation insurance plan meaning that Medicare should not be paying for past and future treatment that is compensable under workers’ compensation. If Medicare does pay for
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