The United States Supreme Court (SCOTUS) found in favor of the employee group health plan (Marietta) and rejected the dialysis company's (DaVita) claims that the Plan discriminated against patients with ESRD.
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The United States Supreme Court (SCOTUS) is set to decide a case concerning what qualifies as a conditional payment, and the ability of health care providers to utilize the Private Cause of Action (PCA) in the context of a health plan’s alleged discrimination of Medicare-eligible patients.
Beginning June 4, 2022, CMS will utilize the CDC’s “Table 1: Life Table for the total population: United States, 2019” for the Workers’ Compensation Medicare Set Aside life expectancy calculations.
Narcan, an opioid antagonist, works by blocking the effects of opioid drugs on the central nervous system.
On January 10, 2022, the Centers for Medicare and Medicaid Services added Section 4.3 - The Use of Non-CMS-Approved Products to Address Future Medical Care to the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (“Guide”).
On March 2, 2022, the Centers for Medicare and Medicaid Services (“CMS”) submitted a proposed rule on Medicare Secondary Payer and Future Medicals (CMS-6047) to the White House Office of Information and Regulatory Affairs (OIRA), which if adopted could have a game-changing impact on liability, and perhaps other types of cases throughout the country.
Medical bills are often the ugliest part of a workers’ compensation settlement.
Two state insurance guarantee funds challenged CMS’ definition of a “primary plan” in order to exclude themselves from conditional payments and Section 111 reporting requirements.
Why would I do a Medicare Set-Aside when an individual has an alternative form of health insurance, whether that be through group health insurance after the age of 65 while working for the respondent-employer or through a spouse?
One of the challenging tasks for MSA allocators is persuading CMS to exclude a surgical allocation when a future surgical procedure is mentioned in the medical record.