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…
Read about the PAID Act, now law, in an article co-authored by Synergy’s CEO, Jason Lazarus. The PAID Act helps resolve the hidden lien problem with Medicare Advantage Plans (MAOs – Part C). You can read the article, featured by NAMSAP here.
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…
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…
September 29, 2020 Excerpt from The Art of Settlement Consider this scenario: you represent a current Medicare beneficiary in a third-party liability case. As part of the workup of the case, you determine the client will need future medical care related to the injuries suffered, and you settle the case. Since the client is a…
April 29, 2020 United States of America vs. Carrigan & Anderson, PLLC, Stephen P. Carrigan: U.S. Attorney brings suit against personal injury lawyer and his firm over failing to pay back Medicare for conditional payments By Jason D. Lazarus, J.D., LL.M., MSCC, CSSC In yet another example of Medicare compliance-related issues, a Houston law firm…
March 2, 2020 The 11th Circuit Court of Appeals weighed in on the question of whether the Medicare statute, which provides a three-year timeline to the government to request repayment, applies to a private entity providing Medicare benefits (Medicare Advantage plans). The Court’s answer is that the claims filing provision does not bar a claim…
January 8, 2020 By: Jason D. Lazarus, J.D., LL.M., MSCC The Department of Justice (DOJ) is serious about and intent on enforcement of the Medicare Secondary Payer Act when it comes to conditional payments. There are now numerous examples of these actions being taken by the DOJ. In this instance, the case against a Philadelphia-based…
By Jason D. Lazarus, J.D., LL.M., MSCC The government takes its reimbursement rights seriously and is willing to pursue trial lawyers who ignore Medicare’s interest. On November 4th, 2019, The United States Attorney for the District of Maryland announced that a Baltimore-based law firm paid the United States $91,406.98 to resolve allegations that it failed…
B. Josh Pettingill, MBA, MS, MSCC Are you relying on the carrier’s expert for projecting your client’s future medical expenses? Was your client compensated on your last catastrophic settlement for all future medical exposure or just the Medicare-covered items? It is vital to have a comprehensive independent evaluation completed for future medical care. In most…
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Panter, Panter & Sampedro
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Tom L. Copeland
Jeffrey Meldon & Associates, P.A.
Join Director of Synergy Medical Bill Clinic, Michael Walrath, Esq. as he delves into the differences between “direct provider liens” and mere “medical debts.” In this webinar, he will describe how and why these important distinctions impact the lien resolution process and expected outcomes, while also dictating the various ethical and legal exposures faced by Plaintiffs’ Lawyers, post-settlement. A 15 minute Q&A will follow the presentation.
