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.

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.

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.