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Medicare Set-Asides and Medicare Compliance

Medicare Liens: Another Concern Prior to Settlement?

In our last post, we discussed the issues posed by ERISA liens and how the presence of an ERISA lien can complicate a potential settlement. Another similar issue that complicates settlements is the potential presence of a Medicare lien. This applies to workers’ compensation and liability cases. The Medicare Secondary Payer Act (MSPA), 42 U.S.C. […]

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Centers for Medicare and Medicaid Services (CMS) Maintains $750 Reporting Threshold

The SMART Act requires CMS to annually review the costs associated with the collection of Medicare conditional payments and set forth a threshold amount applicable to settlements, judgments, awards or other payments (TPOC amount) for which it would not seek recovery. The threshold amount for 2018 was $750. On November 15, 2018, CMS announced the […]

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Centers for Medicare and Medicaid Services (CMS) Maintains $750 Reporting Threshold

The SMART Act requires CMS to annually review the costs associated with the collection of Medicare conditional payments and set forth a threshold amount applicable to settlements, judgments, awards or other payments (TPOC amount) for which it would not seek recovery. The threshold amount for 2017 was $750. On November 3, 2017, CMS announced the […]

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CMS Further Revises the Requirements of the WCMSA Amended Review Process

On July 12, 2017, we issued an alert explaining the new WCMSA re-review process, which is referred to as the “Amended Review” process.  A link to that alert can be found here.  Since that alert, CMS has added another requirement to be able to take advantage of the Amended Review process, which is noted in […]

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Certain Old WCMSAs may now be Re-reviewed by CMS!

A Second Bite at the Apple? CMS Expands the WCMSA Re-Review Process Do you have cases that you cannot settle due to an outdated, CMS-approved WCMSA?  If so, there is good news – CMS has expanded its WCMSA Re-Review process, which allows for resubmission of those old CMS-approved WCMSAs in certain situations. Section 12.4 of […]

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Changes to Medicaid’s Right to Recovery from Injury Settlements is Drawing Near

As a brief background, Medicaid’s recovery rights from tortious settlements and judgments are set forth in federal and state statutes and, at times, have conflicted. In 2006, the United States Supreme Court issued a decision, Arkansas Department of Human Services v. Ahlborn, 547 U.S. 268 (2006), finding that only the portion of a settlement designated […]

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Medicare Beneficiaries Cannot Rely on Estimated Conditional Payment Amounts in Making Settlement Decisions

On March 23, 2017, a decision from the South District of Florida, Shapiro v. Secretary of HHS, 2017 U.S. Dist. LEXIS 42278, confirmed Medicare beneficiaries cannot rely on estimated conditional payment amounts from the Centers for Medicare and Medicaid Services (CMS) in making settlement decisions. The Medicare beneficiary Plaintiff, Shapiro, was injured in an automobile […]

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