May 13, 2021 Rasa Fumagalli JD, MSCC, CMSP-F The conditional payment recovery process in a workers’ compensation claim is not always smooth. Although the workers’ compensation insurance carrier will generally resolve any conditional payments in an accepted claim, the injured employee and counsel may find themselves in receipt of a post-settlement conditional payment notice or…

April 15, 2021 Rasa Fumagalli JD, MSCC, CMSP-F Medicare Secondary Payer (MSP) compliance settlement terms utilized by defendants are often overly broad in nature. The recent opinion, Kupolati v. Village of Timber Creek Association, 2021 N.J. Super. Unpub. LEXIS 7 (App. Div. Jan. 5, 2021) and Abate v. Wal-Mart Stores, No. 1:17-cv-288-SPB, 2020 WL 7027481…

April 8, 2021 Rasa Fumagalli JD, MSCC, CMSP-F The nature of the Workers’ Compensation Medicare Set-Aside (WCMSA) has evolved over the years since the 2001 Patel Memo. That evolution has seen us move from every WCMSA that met the Center for Medicare and Medicaid Services (CMS) internal workload review threshold being submitted to CMS for…

March 11, 2021 Rasa Fumagalli JD, MSCC, CMSP-F Medicare Secondary Payer compliance issues in workers’ compensation cases are generally straightforward when the parties seek review of the Workers’ Compensation Medicare Set-Aside (WCMSA) proposal and proposed settlement by the Centers for Medicare and Medicaid Services (CMS). Oftentimes the employer/carrier will elect to fund the CMS-approved WCMSA…

February 3, 2021 Rasa Fumagalli, JD, MSCC, CMSP-F and Jennifer L. Yu, Esq. In stark contrast to the world of worker’s compensation, most attorneys agree that there is a dangerous amount of gray area surrounding the subject of Medicare Set-Asides for liability settlements.  This is so because the Centers for Medicare and Medicaid Services (CMS)…

December 10, 2020 Rasa Fumagalli, JD, MSCC, CMSP-F The Centers for Medicare & Medicaid Services (CMS) recently issued a press release announcing a steady decline in improper payments under the Medicare Fee-For-Service program over the past few years. The improper payment rate decreased to 6.27% in the fiscal year 2020, down from 7.25% in the…

November 12, 2020 By: Rasa Fumagalli, JD, MSCC, CMSP-F The Centers for Medicare and Medicaid Services (CMS) has been slow in providing detailed guidance in the area of liability settlements that include compensation for future medicals. To date, the guidance consists of the May 2011 CMS Stalcup memo and the September 2011 CMS memo regarding…

February 13, 2020 An inquiry that Synergy receives on a regular basis involves a Medicare-eligible claimant who has both a workers’ compensation and a third-party liability companion case. The third-party liability claim has resolved and now the workers’ comp carrier has a lien against the liability claim for the amount that has been paid out…

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…

B. Josh Pettingill Many carriers are moving to “non-submit programs” using Evidence-Based MSAs as the driving force for the change[i]. Getting approval of a Medicare Set-Aside is never required by any law or statute. There are times when not submitting the Workers’ Compensation Medicare Set-Aside (WCMSA) makes sense in order to achieve a resolution. Most…

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…