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

In Duncan v. Liberty Mutual Insurance Company, 2019 U.S. Dis. LEXIS 106265, the U.S. District Court for the Eastern District of Michigan found that a decedent’s Estate (“Plaintiff”) did not have standing to seek double damages against Liberty Mutual (“Liberty”), the decedent’s no-fault PIP carrier. 

Medicare Secondary Payer (MSP) compliance is a detailed, somewhat complicated, and often dynamic field. MSP law and regulations are constantly evolving and subject to some interpretation.

A Medicare Set-Aside (MSA) is a settlement tool used by parties to prevent a cost shift of future injury-related Medicare covered expenses to Medicare when the settlement terms close out liability for future medical.

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.