Amy Bilton was recently quoted in an article by Business Insurance.

Prescriptions for compounded medications should be red-flagged and quickly assessed for more appropriate and cost-effective alternatives. Don’t wait until trial or settlement to address unnecessary use of these medications.

Welcome to the Spring 2019 edition of the Medicare Secondary Payer Compliance Corner.

A few months ago, we submitted an MSA in a case where Lyrica was being prescribed “off-label” for a diagnosis of lumbar radiculopathy.  CMS included it in the MSA.  The inclusion of Lyrica inflated the MSA astronomically, and nearly prevented the case from settling.  I received this question:  “How can the rules just change like this?  Isn’t there some sort of advance notice required for changes like this?  This just isn’t right!”

On April 1, 2019, the Medicare Secondary Payer Recovery Portal (MSPRP) was updated with a new feature, offering primary payers to also pay conditional payment debts electronically.

Projecting for Workers’ Compensation Medicare Set‐Asides (MSA) in order to prevent a cost shift burden to Medicare has been an evolutionary process since it began.

As the new Congress settles in and the presidential campaigns heat up, there is renewed talk of “Medicare for All.”

In March of 2018, the Centers for Disease Control and Prevention reported there were 63,632 drug overdose deaths in 2016; 42,249 (66.4%) involved an opioid.

After a protracted settlement negotiation involving a high six figure Workers’ Compensation Medicare Set Aside approved by CMS, the parties finally reached a settlement.

Section 5(a) of the Illinois Workers’ Compensation Act provides provides that the exclusive remedy for any employee injured as a result of a work-related accident may only pursue benefits that are provided under the Illinois Workers’ Compensation Act or Illinois Occupational Diseases Act.