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Louisiana District Court on LMSAs

On Tuesday, March 13, 2012, the Western District of Louisiana heard arguments regarding a potential Liability Medicare Set-Aside (“LMSA”).  The argument was brought to the court on the “Motion for Determination of Need for, and the Amount of Medicare Set Aside.”

While the court heard testimony from Plaintiff Warren Frank’s treating physician and his pharmacist, it did not appear to take into account background on the legality of LMSAs.  CMS provided a two paragraph response to the invitation for it to participate:

“CMS [The Centers for Medicare and Medicaid Services] does not review or verify counsel’s determination of whether or not there is a recovery for future medical services or counsel’s determination of the amount to be held to protect the Medicare Trust Fund except under limited circumstances.

“In this particular matter, CMS would neither participate or review the parties’ determination of whether a set aside was needed or the amount of the set-aside.”

The Court also cited Bradley v. Sibelius in its review while discussing CMS was given that chance to appear at the MSA hearing.  It also cites Bradley to show that CMS’s manual is not entitled to Chevron (admin law) deference.

 

The Court’s Findings of Fact

Here is where things get interesting and possibly make this case much less important.  Finding of Fact #1 noted the injury occurred “in a workplace accident…[Frank] was employed by Ranch Supply and was unloading merchandise off of a trailer.”  So – the underlying case is a workers’ compensation case with a liability case component (his injury occurred when he stepped in a hole in the trailer).  This  means we aren’t actually looking at apure LMSA.

Within Finding of Fact #6, the court also noted (in a pure LMSA context), “CMS does note currently require or approve Medicare Set Asides when personal injury lawsuits are settled.”

 

What does it mean for LMSAs?

This is just another case to add to the research pot.  Obviously, we question its applicability to the LMSA argument based on the workers’ compensation component; however, it is technically an LMSA.  More important is the Court’s response to CMS’s refusal to attend.  The Court will not allow CMS to be defiant in the case of unsettled law.

Please contact us for any lien resolution support or assistance.  In addition to Medicare lien resolution, we can assist you with Medicaid lien resolution, ERISA subrogation, private insurance companies’ liens, and more.

 

Ryan J. Weiner
Co-Founder Lien Resolution Services
www.lienresolutionusa.com
https://lienblog.wordpress.com
rweiner@lienresolutionusa.com
This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.

 

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About Ryan J. Weiner

Co-Founder of Lien Resolution Services, LLC, a national healthcare lien resolution firm. Our goal is to assist in the fair administration and resolution of healthcare liens on personal injury cases. Please visit our website for more information: www.lienresolutionusa.com.

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