Category Archives: MEDICARE COMPLIANCE

Liability Medicare Set-Asides (LMSAs): Is It Time to Start Worrying?

B. Josh Pettingill For over a decade, there has been episodic activity from Centers for Medicare and Medicaid Services (CMS) on Liability Medicare Set-Asides (LMSAs), including but not limited to, policy memorandums, Medicare Learning Network announcements, a notice of proposed rulemaking with subsequent withdrawal, an advanced notice of a notice of proposed rulemaking as well…

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The Interplay between Medicare and Medicaid for Injured Workers

Jason D. Lazarus, Esq. This blog post will discuss dual eligibility for injured workers.  It will address exactly what it is and how Medicaid coordinates with Medicare for those that are dual-eligible.  Finally, it will talk about the techniques to preserve Medicaid and Medicare. Some individuals are “dual eligible” meaning they qualify for both Medicaid…

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Injury Victim Gets Part B Denial of Care by Medicare

Jason D. Lazarus, J.D., LL.M., CSSC, MSCC In the past, trial lawyers never had to worry about whether Medicare would pay for their client’s future care post-settlement. There is cause for concern that this may not be the case in the future.  Consider this scenario – you represent a current Medicare beneficiary in a third-party…

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Liability Medicare Set-Aside (MSA) Case Studies: Eliminate, Reduce & Comply

B. Josh Pettingill There is mounting evidence that the Centers for Medicare and Medicaid Services (CMS) will establish formal guidelines for liability MSAs in the imminent future.  Medicare Secondary Payor compliance related to future medical care is an issue that can’t be ignored but that doesn’t necessarily mean setting up a Medicare Set-Aside on every…

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How to Close Cases Ethically & Compliantly for Disabled Clients

Jason D. Lazarus Suffering even a moderate personal physical injury can create difficult challenges both financially and emotionally for even the strongest among us.  However, what happens when someone suffers a serious or catastrophic personal physical injury causing permanent disability?  Do they get the proper counseling regarding the form of the settlement to protect their…

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Medicare Advantage Private Cause of Action is Now Sweeping the Country

Medicare Advantage Private Cause of Action is Now Sweeping the Country Courts across the country continue to rule that Medicare Advantage Plans (MAP or MAO) are enforceable and shall be entitled to double damages if not repaid in third party liability situations.  The trial bar has been aware of this significant exposure since 2016 when…

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New Medicare Portal Goes Live January 2016

New Medicare Portal Goes Live January 2016 By David L. Place On November 9th 2015, The Centers for Medicare & Medicaid Services (CMS) announced the much anticipated, and long overdue, start date for the new Medicare Secondary Payer Recovery Portal (MSPRP).  The new MSPRP will begin functioning on January 1, 2016.  The current MSP Web…

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Humana vs. Western Heritage – Double Damages for Medicare Advantage Plans

In Humana Medical Plan, Inc. v. Western Heritage Insurance Co., No. 12-20123, 2015 U.S. Dist.  LEXIS 31875, the U.S. District Court for the Southern District of Florida granted Humana’s Motion for Summary Judgment and held that Humana’s right to reimbursement for the conditional payments it made on behalf of plan beneficiary under a Medicare Advantage…

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SMART ACT APPEALS FOR PLANS

SMART ACT APPEALS FOR PLANS By: Dave Place, J.D., Vice President, Director of Lien Resolution Services, Synergy Settlement Services On February 27, 2015 the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing provisions of the Strengthening Medicare and Repaying Taxpayers Act (SMART Act), establishing a right of appeal and formal Medicare…

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ALERT – Medicare Raises Reporting Threshold From $300 to $1,000

Medicare has increased the threshold for when a physical trauma-based liability settlement is large enough that the beneficiary need report it and repay conditional payments.  On February 18, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued an alert which increases the current reporting threshold from $300 to $1,000.   The threshold increase is a…

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What is the SOL for Medicare Conditional Payments?

By Dave Place, J.D., Director of Lien Resolution

What is the statute of limitations for Medicare to institute an action for repayment of conditional payments used to be a question with more than one answer.  The SMART Act has answered the question. 

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Add the Administrative Services Agreement to your ERISA Document Request

An Administrative Services Agreement between a Plan Administrator and a Claims Administrator may fall within the purview of a document request under ERISA 29 U.S.C. § 1024(b)(4), with non-compliance subject to the penalty assessment authorized under ERISA 29 U.S.C. § 1132(c).   As Synergy has long advocated, one of the keys to properly defending against an asserted subrogation or reimbursement claim from an ERISA plan is making requests to the plan administrator.

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Synergy reduces self-funded ERISA plan by over 70% for a savings of $85,955.02

This case involved a Virginia plaintiff who was injured when a shower chair collapsed.  The plaintiff had a pre-existing hip injury which involved an implanted prosthetic.  Plaintiff’s counsel engaged Synergy Lien Resolution Service to assist in the resolution of the ERISA plan’s reimbursement claim.  Despite the unfavorable law in the 4th Circuit, which was recently bolstered by U.S. Airways v.McCutchen, within two (2) weeks Synergy was able  to obtain a 70.2% reduction for a savings of $85,955.02.

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“Synergy is our guiding light for deferring our contingent legal fees and planning for retirement. The lawyers at Panter Panter & Sampedro, myself included, have been working with them for over ten years using different methods to defer comp and plan for retirement.”

Brett Panter
Panter, Panter & Sampedro

"I don't think I've directly said "thank you" for helping us with Bridgett’s case. We sent the reduced payment to Medicaid and called Bridgett's mom to tell her approximately how much money was going to be left for Bridgett and she broke down over the telephone. Given only $25k of insurance and a $850k medical bill from the hospital she didn't think Bridgett would ever see a penny."

Tom L. Copeland
Jeffrey Meldon & Associates, P.A.

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Liability MSAs: Is It Time To Worry? Third Thursday Webinar

Join us this month for a special presentation by Synergy's Vice President, Medicare Secondary Payer Compliance, B. Josh Pettingill, to discuss the Centers for Medicare and Medicaid Services' (CMS) potential regulations on Liability MSAs and best practices for protecting your law firm as it relates to MSP compliance, including Medicare Advantage. A 15-minute question and answer session will follow.