MSP Compliance
SMART Act: Final/Conditional Medicare Lien Process
Looking back at yesterday’s SMART Act post it is hard to decipher how to properly obtain what we are calling a “Final Conditional” Amount or Lien. We hope the following workflow (including our assumptions and expectations of the future process) will help: T-120 days to settlement – Send an Expected Settlement Notice to the MSPRC; […]
SMART Act: Is Medicare Lien Resolution Smarter Now?
On January 10, 2013, President Obama signed H.R. 1845. Included on the Medicare IVIG Access Bill is the SMART Act. SMART was designed to reform the conditional payment, final demand, and MMSEA Section 111 reporting processes. Click here to read the full text of H.R. 1845. As you can see below, we aren’t as excited […]
House & Senate Pass Medicare’s SMART Act
Both the House and Senate passed the SMART act prior to the Christmas holiday last week. In the House just 3 “no” votes were cast against 401 “yes” votes. The Senate passed the act without a single “no” vote. There is little doubt that President Obama will sign the bill into law. What is the […]
NJ Court: Federal Law Does NOT Mandate Medicare Set-Asides
The United States District Court of New Jersey recently stated (albeit in an Unpublished Opinion) that Federal Law does not mandate Medicare Set-Asides in a liability context. The question arose in Sipler v. Trans. Am. Trucking Inc. following a general settlement for $225,000. After the verbal settlement the defense attorney attempted to insert language stating: […]
Medicare Advantage Plans Entitled to Medicare Liens
In late June, the 3rd Circuit held that Medicare Advantage Plans (“MAP” or “MAPs”) have the same rights to reimbursement as regular Medicare. The district court in In Re Avandia Marketing, 2011 U.S. Dist. LEXIS 63544, (E.D. Penn. 2012) originally held the plans do not have the same rights to reimbursement as regular Medicare. However, […]
Misconceptions: It’s Not a Valid “Lien” Unless They Put Me on Notice
The most troubling “liens” are the ones that come up unexpected. But why do liens come up without warning? For starters, we have to remind you that we all use the term lien loosely. Most of the time we are not dealing with liens at all. The usual encumbrance is either a subrogation right, a […]
Liability MSA (LMSA) Cases Cited by the MSA Industry
Many of those involved in the MSA industry (including CMS officials) point to “LMSAs” being approved by Federal District Courts. These cases are circulated on listservs and message boards as reminders that LMSAs may be necessary in certain cases. These cases all carry one extra piece of information worth noting: the underlying injuries were the […]
The Congressional Failure to Understand Medicare
Congressman Dennis Ross (Republican – Lakeland, Fl) spoke to the National Association of Medicare Set Aside Professionals (“NAMSAP”) convention on Friday, March 30, 2012. Congressman Ross’s topics were Medicare liens and Medicare Set-Asides. Note: I started this post as a recap of Congressman Ross’ talk with NAMSAP – but it turned into an 1111 word rant […]
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, […]
MSPRC Website: Liability Medicare Set-Asides are NOT Required
Direct from the horse’s mouth (but I can’t take credit – thanks to the NAMSAP Listserv for this catch: This image is from MSPRC.info – the website of Medicare’s agent. It is just another argument that LMSAs are simply not required and cannot be required for Medicare […]
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