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.”

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

When Medicare seeks recovery of conditional payments out of a settlement, judgment, or award from a beneficiary (as opposed to a primary plan), the conditional payment lien may be reduced by procurement costs (e.g. attorney’s fees). 

Over the years, we’ve been confronted with glaring headlines involving lawsuits that appear ridiculous. At times however, the plaintiffs may produce sufficient evidence to support their claims, as in the McDonald’s third degree burns from hot coffee litigation.

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.