Hear what our attorneys are saying

01
Nov 2018

Not So Fast MSPA Claims

By Geraldine Balow     

  In response to the question whether the Medicare Secondary Payer statute preempted the state’s automobile no fault law, the State of Florida Third District Court of Appeal responded with an emphatic No! Ocean Harbor Cas In. v. MSPA Claims (2018 Fla. App. LEXIS 13775) involved the intersection of the law of Florida class actions,
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01
Nov 2018

The Yin and Yang of MSP Compliance in the Disputed Claim

By Rasa Fumagalli     

  The Medicare Secondary Payer Act provides that Medicare is a Secondary Payer when a primary payer has responsibility for payment. Responsibility for payment may be “demonstrated by a judgment, a payment conditioned upon the recipient’s compromise, waiver or release (whether or not there is a determination or admission of liability) of payment for items
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01
Nov 2018

UR: What Is It Good For?

By Julie A. Garrison     

  You may have asked that question lately. In the management of workers’ compensation claims, Utilization Review (UR) provides a process whereby proposed treatment is assessed for medical necessity and reasonableness. In several states, the UR process is mandatory and employers or their claims administrators are required to have a UR program. Some states, like
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18
Sep 2018

Workers’ Compensation, the World Trade Center Health Program and CMS

By Rasa Fumagalli     

  It has been 17 years since the devastating September 11, 2001 terrorist attacks on US soil. As we move further away from the event however, it is apparent that the list of health conditions related to the toxic chemical exposures at the devastation sites is growing. In addition to the obvious respiratory and psychological
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12
Sep 2018

Lyrica: Is It In or Out?

By Rasa Fumagalli     

  Lyrica has been the subject of recent discussions within the Medicare Set-Aside professional community. Submitters have been surprised to find CMS including Lyrica in WCMSA determinations in situations where it had previously been excluded. Since the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (Version 2.7, March 19, 2018) purports to explain the process
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