It is a fairy universal policy that no-fault carriers must make immediate payment for medical treatment and seek reimbursement later if found to be so entitled. Well what happens when the entity that should have made payment was Medicare and you can't sue the federal government?  US Court of Federal Claims just released an option in which it dismissed a claim by the Auto Club Insurance Association for reimbursement of payments it made on behalf of a Medicare ...

Now that Jen is done Monday morning quarterbacking 2011, it is time to ply my idiot savant like clairvoyance to events that will surely come to pass in 2012. (Nonbelievers, see my 100% accurate 2011 precognition on permanent display here). While it may seem my prognostications are a few days late, keep in mind I work off the Mayan calendar.

As we approached the end of the year, I was asked to contribute to a number of different articles recapping the year and making predictions for 2012. Most requests focused on workers’ compensation and none really captured just how active the MSP arena was in 2011. For those of us who remember the early days, a new CMS memo may have ...

CMS’ First Official LMSA Policy Published

While of little significance to someone like myself who always read the express terms of the MSP to include “workers’ compensation, liability, auto, no-fault and self-insurance,” CMS has finally acknowledged the existence of Liability Medicare Set-Asides in writing. The acceptance of the need for MSAs in liability settlements has been fought since the inception of WCMSAs. Whether the ...

6th Circuit Decision in Hadden v. US Appeal

After only a little over 400 days of deliberation, the 6th Circuit Court of Appeals finally rendered a decision in the appeal of U.S. v. Hadden on November 21, 2011, upholding Medicare’s right to recovery in full from Mr. Hadden’s insurance settlement. For those unfamiliar, Mr. Hadden was a pedestrian struck by a public utility vehicle that swerved ...

MSP Captured Congressional Attention

Although there have been MSP-related bills presented to Congress in years gone by, H.R. 4796 was the first to really capture its attention, despite having little chance of scoring. Whether due to the lobbying efforts of the MARC Coalition or it was just time for Congress to see what all the fuss was about, Congressman Pete Stark set ...

MSP Compliance Insurance Hits the Market

Given that we are working within the risk management industry, it has been incredibly surprising that we have not seen more insurance solutions enter the MSP marketplace over the years. As big a disaster as the Coventry guaranteed MSA program turned out to be, the concept was headed in the right direction. Although all the issues not very well thought out, or ...

New Conditional Payment Reimbursement Policies

Much like the dismissal of the Chickasaw Nation, CMS took additional subsequent remedial measures to deal with the embarrassment before Congress last summer. Following the questioning regarding the cost of pursuing nominal recoveries, CMS suddenly issued several new policies for conditional payment recoveries in liability insurance settlements. In September, CMS announced that ...

Haro v. Sebelius Injunction

In April, the United States District Court for Arizona certified a class of Medicare beneficiaries and enjoined CMS from putting recovery claims into collections while pending a waiver or compromise request. Makes sense, but in the past, CMS would routinely make such egregious threats in demand letters, all but requiring that you surrender your first born in ...

Chickasaw Nation Industries Loss of MSPRC Contract

While we’re talking about contractors, the sudden dismissal of the MSPRC contractor was an interesting development. It was assumed that, in CMS tradition, the Chickasaw nation would continue indefinitely in contract extensions. Yet after an embarrassing display before the Energy and Commerce Subcommittee on Health in July, CMS elected to save face and allow the contract to simply end on its terms. For ...

I get a lot of notices every day of court opinions that were published throughout the country, most of which I dismiss when they don't have an interesting MSP angle. This morning however, I can't help but share, probably because the whole time I read it, I kept shaking my head wondering what CMS would do with the facts of the case because even more surprising that the suit being filed at all was the fact that the lower ...

WCRC Contract Delays

It’s only fitting that the WCRC contract delays make the next spot on the list. To compound all of the already existing inefficiencies baked into the WCMSA review process, 2011 was riddled with contractor drama. As you may be aware, the WCRC contract was involved in a re-compete and awarded to Provider Resources, Inc. in June 2011. The award was immediately followed ...

See Peter's thoughts on 2011 developments that are going to continue to be significant cost drivers in 2012.

I think his article delivers a critical message in that with workers' compensation insurers incurring losses and other expenses of about $1.20 per every dollar of premium, 2012 apparently needs to be year to take action to control costs. But instead of tackling ...

WCMSA Web Portal

CMS is finally taking CMS submissions electronically and the overwhelming response is “it’s about time.” While CMS does receive some paper submissions, MSA vendors send the majority of files electronically and have done so for many years now; however, the files all went to a post office box in Detroit where a contractor existed for the sole purpose of receiving MSP-related mail ...

As we approached the end of the year, I was asked to contribute to a number of different articles recapping the year and making predictions for 2012. Most requests focused on workers’ compensation and none really captured just how active the MSP arena was in 2011. For those of us who remember the early days, a new CMS memo may have proved for an exciting shake up in the MSP world. Now we have to monitor published ...

To kick off 2012, Larson's Workers’ Compensation Law Community in conjunction with Work Comp Roundup has published an article clarifying 10 WC myths. Industry leaders from throughout the WC community contributed to this article, so there is a little something for everyone. In the interest of new starts for the new year, we encourage our readers to visit this link to see if dispelling at least one myth ...

Just in case you didn't get your email notifying you of a change to the MMSEA Section 111 web site, probably because none were sent, we just wanted to bring to your attention that an update to the user guide has been posted. It is hard to determine exactly when it was posted considering that the title to the link to the document is dated November 9, 2011, the document bears ...

Ametros Financial, the upstart professional administrator, has named Tom Ash its new CEO. See press release here.

Comment: This company entered the market last year promising lower fees than previously seen in the professional administration market. They claim these lower fees (which range from $1,000-$1,500 initial set-up and less than $500 per year ongoing) are possible due to a new technology platform that automates many of the functions currently performed by ...

Beginning in February 2012, for settlements of $25,000 or less involving physical trauma based injuries where treatment has been completed, the beneficiary or their representative may be able to obtain a final conditional payment amount prior to settlement. The beneficiary/representative may calculate the final conditional payment amount utilizing information obtained from the MSPRC, the MyMedicare website or other claims information to calculate a proposed final conditional payment amount. The proposed conditional payment amount is then submitted to ...

Who knew? See article here

WARNING: Not suitable for people who get upset at government waste or children under the age of 12.