In an Amended Review submission, CMS considered NBKL’s argument that a Claimant’s current treatment regimen changed, and that some of the pending treatment recommendations should be excluded.

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

Question:  We recently learned that an injured worker is using an American citizen’s Social Security number, and that American citizen is a Medicare beneficiary.  The worker using that Social Security number is technically undocumented, however, and is 64 years old.  What do I need to do in my settlement to remain in compliance with the Medicare Secondary Payer Act?

In the fall of 2018, the Department of Health & Human Services/CMS published an abstract of a proposed rule entitled “Miscellaneous Medicare Secondary Payer Clarifications and Updates.”

As of January 1, 2019, Medicare Part D prescription drug plans began implementing a three part plan to help combat the nation’s opioid epidemic.

On January 4, 2019, CMS released its updated Non-Group Health Plan User Guide Version 5.5 detailing changes made to Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007.

The Private Cause of Action provision of the Medicare Secondary Payer Act (MSP) (42 U.S.C. Section 1395 y(b)(3)A) remained  the focus of much of the MSP litigation in  2018.

In February, 2018, Performant Financial Corporation (parent organization of Performant Recovery, Inc. “Performant”) replaced CGI Federal as the lead contractor in the Commercial Repayment Center (“CRC”) operations.

The Centers for Medicare and Medicaid Services (CMS) is tasked with approving future medical plans in settlements for workers’ compensation claims of Medicare beneficiaries or those who will soon become Medicare eligible.

Workers’ compensation and personal injury claims adjusters and attorneys spend a great deal of time analyzing medical records in connection with their cases.