B. Josh Pettingill, MBA, MS, MSCC Introduction A vital step to navigating the MSP statute is understanding the dynamics between the Section 111 Reporting Requirement and the potential interplay for a Liability Medicare Set Aside (LMSA). The MSP statute precludes Medicare from paying for any item or service when payment has been made by a […]
By B. Josh Pettingill, MBA, MS, MSCC & Jason D. Lazarus, J.D., LL.M., MSCC The debate regarding addressing Medicare’s future interest in liability settlements is filled with nuance and subtleties. An essential step in understanding the big picture is starting with the genesis of set asides, the Medicare Secondary Payer (MSP) Statute. Although, the finer […]
By Jason D. Lazarus, J.D., LL.M., MSCC “Although the statute is structurally complex—a complexity that has produced considerable confusion among courts attempting to construe it—the MSP’s function is straightforward.” US v. Baxter Intern., Inc., 345 F. 3d 866 (11th Cir. 2003). Attorneys are consistently exposed to liability risks when handling cases for Medicare beneficiaries. This […]
By B. Josh Pettingill Last week, the Centers for Medicare and Medicaid Services (CMS) released a “CMS Manual System” “One-Time Notification” regarding Liability Medicare Set Asides and enforcement of the Medicare Secondary Payer statute (MSP). Starting October 1, 2017, Medicare and their contractors will reject medical claims submitted post-resolution of a liability settlement on the […]
B. Josh Pettingill, MBA, MS, MSCC In the absence of formal guidance from Centers for Medicare and Medicaid Services (CMS), the plaintiff’s bar and the insurance industry have not agreed upon the appropriate way to protect Medicare’s interests when resolving a liability case that funds future medical needs. This brief article will explain this disconnect […]
Synergy receives numerous calls every week regarding what is required to properly self-administer an MSA. The purpose of this article is to provide some guidance to attorneys regarding self-administered Medicare set aside (MSA) accounts. In administering MSAs, funds may only be used to pay for future Medicare covered, injury related medical expenses of the plaintiff.
By B. Josh Pettingill, MBA, MS, MSCC Plaintiff attorneys should go on the offensive in regards to any Medicare set aside (MSA) issue that may arise in a personal injury case involving a current Medicare beneficiary. According to the May 25, 2011 CMS policy memorandum issued from the Dallas regional office, an MSA is never […]
By Jason D. Lazarus, J.D., LL.M, MSCC Recently, an Arizona Federal judge ruled that he would not make a determination on whether a Medicare Set-Aside (MSA) is necessary on a medical malpractice case. According to Judge Stephen McNamee: [t]he Court finds that there is no justiciable case or controversy ripe for review. As such, the […]
By B. Josh Pettingill, MBA, MS, MSCC Traditional Medicare vs. Medicare Advantage Plans There is often confusion between “Traditional Medicare”, Part A and Part B coverage and Medicare Advantage Plans. It is critical to identify exactly what benefits your client is actually receiving before the resolution of their case. The best time to confirm public […]