The US 9th Circuit Court of Appeals has ruled that The Centers for Medicare and Medicaid [CMS] cannot not seek reimbursement from from the California Insurance Guarantee Association for workers' compensation payments.
Showing posts with label Reimbursement. Show all posts
Showing posts with label Reimbursement. Show all posts
Friday, October 11, 2019
Friday, September 27, 2013
The High Price of Gas – Mileage Reimbursement for Injured Workers
Some states like NJ offer zero mileage reimbursement. Today's post comes from guest author Laurel Anderson, from Causey Law Firm.
By Laurel Anderson from Causey Law Firm
Injured workers who are are dependent on time loss compensation payments of only 60-75% of their wages unfortunately are well used to the enormous financial losses and constraints this wage loss puts on their family budgets. With budget cuts being made by the Department of Labor & Industries which place additional burdens on workers by reducing reimbursements for the additional costs incurred as a result of an injury, it is important to be aware of what you can be reimbursed for, and what some relatively new regulations do not cover. The current mileage reimbursement rate is now 56.5 cents per mile.
When money is tight, making sure you receive everything you are entitled to under your claim is important!
Injured workers are always entitled to receive travel and/or wage reimbursement if they are asked to attend an IME (Independent Medical Exam). However, we have noted that more recently both the Department and self-insured employers are failing to provide workers with the form necessary to be reimbursed gas mileage for what are often not insignificant distances. Many workers are unaware they can have their wages reimbursed as well if they miss time from work. The form can be found online here. When self-insured employers do not provide our clients with a reimbursement form when sending out IME notices, we will send out the Department’s standard form.
More difficult to decipher are the rules allowing for travel reimbursement for medical treatment or vocational services. A different form must be filed to obtain reimbursement for these expenses. At Causey Law Firm, we insure that our clients are reimbursed for travel for vocational meetings which take place in our office. Parking is expensive in Seattle, and that cost can be reimbursed to you directly. Some law firms charge a fee on travel reimbursement expenses, but we do not.
While injured workers have the right to treat with their own preferred provider, travel reimbursement is only paid for regular treatment visits if there is no adequate treatment provider within 15 miles of their home AND if the claims manager has pre-authorized the travel. Travel reimbursement is now limited for regular medical treatment visits by the so-called “15 mile rule”. Thus, if your pre-authorized provider is 30 miles from your home, reimbursement will only be provided for the last 15 miles each way of that trip. As with medical appointments, regular visits to meet with a vocational counselor are only covered after that 15 mile threshold has been reached. If you are approved for a formal vocational retraining plan, however, mileage may be fully reimbursable through your plan with necessary signatures and paperwork submitted through a vocational rehabilitation counselor.
Many workers are unaware of their right to apply for reimbursements, which can be submitted to the Department for a period up to one year of the date of travel. The Department’s general guidelines can be seenhere. When money is tight, making sure you receive everything you are entitled to under your claim is important!
Thursday, September 5, 2013
9th Circuit Vacates MSP Injunction Against CMS for Medicare Reimbursement
The 9th Circuit Court of Appeals has vacated a Federal District Court Order enjoying CMS from seeking reimbursement for Medicare Conditional Payments under the Medicare Secondary Payer Act (MSP).
The Court held that it lacked jurisdiction:
****
Read prior posting about this case:
The Court held that it lacked jurisdiction:
"... we conclude that the***
beneficiaries' claim was not adequately presented to the
agency at the administrative level and therefore the district
court lacked subject matter jurisdiction pursuant to 42 U.S.C.§ 405(g) .
" Federal question jurisdiction does not extend to most
claims arising under the Medicare Act. The Medicare Act
incorporates 42 U.S .C. § 405(h) , which provides:
No findings of fact or decision of the
[Secretary] ... shall be reviewed by
any person, tribunal, or governmental
agency except as herein provided.
No action against the United States,
the [Secretary] ..., or any officer or
employee thereof shall be brought
under section 1331 ... of title 28 torecover on any claim arising under this
subchapter.
42 U.S.C. § 405(h) ; 42 U.S.C. § 1395ii .
****
"We decline to adopt the extraordinarily broad reading of***
Eldridge that the beneficiaries invite. We conclude that the
named plaintiffs' reimbursement disputes did not provide an
opportunity for the Secretary to consider the claim that her
interpretation of the secondary payer provisions exceeded
her authority. Their requests for redetermination of their
respective amounts of reimbursement did not constitute
presentment of their policy challenge.
" We conclude that the beneficiaries' claim wasHaro v Sebelius, ___F.3d____, No. 11-16606, 2013 WL 4734032, Decided Sept.4, 2013.
not presented to the agency. Because presentment is a
jurisdictional requirement under § 405(g) , the district court
lacked subject matter jurisdiction over the beneficiaries'
claim.
Read prior posting about this case:
May 18, 2011
Haro v. Sebelius, 2010 WL 1452942 (A. Ariz.) CV 09-134 TUC DCB, Decided April 12, 2010.The plaintiffs were permitted discovery beyond the administrative record. The class action is challenging the recovery procedures of ...
May 25, 2011
The MSPRC is still working cases, and the RAR and Demand letters will be mailed out once appropriate revisions have been made." This follows a recent US District Court ruling enjoining CMS's collection procedures. Haro v.
….
Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
Wednesday, July 31, 2013
Liability Claim Collateral Source Payments Subject to MSP
Medicare is not required to abide by a stipulated order of allocation of benefits in a liability case when seeking reimbursement under the Medicare Secondary Payer Act (MSP). Also, the New Jersey Collateral Source Statute (“NJCSS”)did not apply to MSP reimbursement claims and collateral proceeds were reimbursable.
" For the reasons described above, the Court concludes that it lacks subject matter jurisdiction over Ms. Taransky's “due process” and “proportionality” claims, as Ms. Taransky failed to administratively exhaust these claims. Additionally, the Court concludes that there is substantial evidence in the record supporting the MAC's properly-reasoned conclusion that in obtaining a tort settlement in a trip-and-fall accident, and notwithstanding a state trial court's order allocating this tort settlement recovery to non-medical expenses, Ms. Taransky received payment from a “primary plan” responsible for payment of her medical expenses that had been covered by Medicare. As a result, Ms. Taransky is required to reimburse Medicare $10,121.15 pursuant to the MSP."
Taransky v. Sebelius, Civil Action No. 12-4437, 2013 WL 3892360 (D. NJ 2013) June 13, 2013
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| English: image edited to hide card's owner name. author: Arturo Portilla (Photo credit: Wikipedia) |
Taransky v. Sebelius, Civil Action No. 12-4437, 2013 WL 3892360 (D. NJ 2013) June 13, 2013
Tuesday, January 22, 2013
US Supreme Court Upholds Equitable Tolling In Reimbursement Matter
US Supreme Court Upholds Equitable Tolling In Reimbursement Matter
Sebelius v. Auburn Regional Medical Center, Decided Jan. 22, 2013
Sebelius v. Auburn Regional Medical Center, Decided Jan. 22, 2013
"But this Court has explained that giving intermediaries more time to discover overpayments than providers have to discover underpayments may be justified by the “administrative realities” of the system: a few dozen fiscal intermediaries are charged with issuing tens of thousands of NPRs, while each provider can concentrate on a single NPR, its own. Your Home Visiting Nurse Services, Inc. v. Shalala, 525 U. S. 449, 455, 456. Pp. 11–14. "
See full analysis on Scotus Blog.
Read more about equitable tolling:
See full analysis on Scotus Blog.
Read more about equitable tolling:
Nov 13, 2012
ERISA health reimbursement claims asserted in Workers' Compensation claims may be subject to equitable relief depending on the upcoming decision in a case pending before the US Supreme Court. Oral argument is ...
Nov 22, 2011
The Doctrine of Equitable Allocation Not Applicable in a Medicare Secondary Payment Reimbursement Claim. The 6th Circuit Court of Appeals has ruled that The Center for Medicare and Medicaid Services (CMS) is entitle to ...
Nov 29, 2012
The US Court of Appeals for the Third Circuit, in defiance of several other circuits held [opinion] that "appropriate equitable relief" did not include revoking the payment to McCutchen. Interestingly enough at oral argument ...
Dec 05, 2011
US Supreme Court Maybe Asked to Rule on CMS Issue: "The Doctrine of Equitable Allocation". The 6th ... The Doctrine of Equitable Allocation Not Applicable in a Medicare Secondary Payment Reimbursement Claim A recent ...
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