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Monday, May 23, 2011
CMS Announces Review is Only a Recommended Process for Set-Aside Agreements
Monday, June 30, 2014
Medicare Takes Bigger Bite Out California Workers Compensation
Since July 23, 2001(The date the Patel Memo was issued) a dramatic increase in the elimination of the Federal "subsidy" of future medical care for compensable work-related conditions has also been reported. In California a 40% increase has been also reported in the last year from $92Million to $129Millon for Medicare Set Aside Agreements.
Click here to read the entire report.
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Tuesday, September 30, 2014
Federal Appeals Court Rules State Apportionment Order Not A Bar to Medicare Recovery
The Court of Appeals, Hardiman, Circuit Judge, held that:
(1) recipient's liability settlement from third-party tortfeasor qualified as a “primary plan” within the meaning of the Medicare as a Secondary Payer Act;
(2) recipient's $90,000 settlement with tortfeasor included her medical expenses, and thus recipient had obligation to reimburse Medicare for $10,121.15 in medical
(3) the New Jersey Collateral Source Statute (NJCSS) did not prevent Medicare from recovering medical expenses as part of her damages in tort suit;
(4) state court's order apportioning settlement proceeds did not bar government from seeking reimbursement for medical expenses;
(5) District Court lacked jurisdiction to adjudicate recipient's unexhausted claim pursuant to “equity and good conscience” exception under Act; and
(6) District Court lacked federal question jurisdiction over due process claim.
"As the ALJ correctly found, the Superior Court's apportionment order was not “on the merits,” and need not be recognized by the agency. A court order is “on the merits” when it is “delivered after the court has heard and evaluated the evidence and the parties' substantive arguments.” Black's Law Dictionary 1199 (9th ed.2009); cf. Greene v. Palakovich, 606 F.3d 85, 98 (3d Cir.2010) (finding, in a criminal case, that “on the merits” means the state court “acted on the substance of [the] claim”), aff'd sub nom. Greene v. Fisher, ––– U.S. ––––, 132 S.Ct. 38, 181 L.Ed.2d 336 (2011); Thomas v. Horn, 570 F.3d 105, 115 (3d Cir.2009) (holding that state proceedings occur “on the merits” “when a state court has made a decision that 1) finally resolves the claim, and 2) resolves the claim on the basis of its substance”). Here, the state court did not adjudicate any substantive issue in the primary negligence suit. Indeed, in her motion for the order, Taransky clarified that she sought an apportionment not to resolve any outstanding issue in her suit, but “only to the extent necessary to obtain specified documentation relevant to anticipated administrative proceedings with the federal Centers for Medicare and Medicaid Services.” JA at 267. The state court, in effect, rubber stamped her request. Taransky's motion was uncontested, issued pursuant to a stipulation between Taransky and Larchmont, and prepared and submitted by Taransky's counsel for the judge's signature. This order is the antithesis of one made on the merits."
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- Court Permits Deduction of Procurement Costs From Medicare Set-Aside in Liability Claim (workers-compensation.blogspot.com)
- NJ Court Approves Medicare Set-Aside Agreement Lacking CMS Review(workers-compensation.blogspot.com)
- US Supreme Court Denies CMS-MSP Case - Hadden (workers-compensation.blogspot.com)
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Tuesday, January 3, 2012
Annual Reporting of WCMSA Account Expenditures
MSPRC - Non-Group Health Plan (NGHP)
P.O. Box 138832
Oklahoma City, OK 73113
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Monday, June 20, 2011
CMS Recovery Contractor Publishes New Rights and Responsibilities Letter
CMS employs outside contractors to collect conditional payments that Medicare has paid and for which it is only secondarily responsible
"The Medicare Secondary Payer Recovery Contractor (MSPRC) protects the Medicare trust fund by recovering payments Medicare made when another entity had primary payment responsibility. The MSPRC accomplishes these goals under the authority of the Medicare Secondary Payer (MSP) Act. The MSPRC identifies and recovers Medicare payments that should have been paid by another entity as the primary payer either under a Group Health Plan (GHP) or as part of a Non-Group Health Plan (NGHP) claim which includes, but is not limited to Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers' Compensation. The MSPRC does not pursue supplier, physician, or other provider recovery'."
For over 3 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.
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- Federal Court Enjoins CMS From MSP Recovery Procedures (workers-compensation.blogspot.com)
- Court Permits Deduction of Procurement Costs From Medicare Set-Aside in Liability Claim (workers-compensation.blogspot.com)
- CMS Announces Review is Only a Recommended Process for Set-Aside Agreements (workers-compensation.blogspot.com)
Wednesday, August 6, 2014
Third Circuit Court of Appeals Enforces Medicare Conditional Payment Collection
Taransky v Sec of US HHS No. 13-3483, 214 WL 3719158 (Decided July 29, 2014)
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Tuesday, July 26, 2011
7 Problems Facing Work Comp in a Credit Default
White House Photo, Pete Souza, 7/25/11 |
The consequences of a US credit default will be significant. President Obama stated, "If that happens, and we default, we would not have enough money to pay all of our bills -– bills that include monthly Social Security checks, veterans’ benefits, and the government contracts we’ve signed with thousands of businesses. "
1. Centers for Medicare and Medicaid Services (CMS) and their contractor will be unable to provide conditional payment information under the Medicare Secondary Payer Act. Negotiations in workers compensation matters will come to halt.
2. CMS will be unable to approve compromises and releases in advance of workers' compensation disposition thereby halting the State systems.
3. CMS and their agents will be unable to review Medicare Set-Aside Agreements thereby stopping workers' compensation dispositions by compromise.
4. Chaos will erupt in those States where Social Security takes a reverse offset on permanency payments. Workers' compensation insurance companies and employers will become responsible for the entire amount to be paid.
5. The Veterans' Administration will be unable to provide information concerning medical treatment. Records will he held-up and will delay evaluations in adjudications in workers' compensation cases.
6. Tricare and other federal insurance providers will be unable to provide benefit information. The lack of reimbursement data will stymie evaluation of medica reimbursement issues slowing the disposition and settlements of workers' compensation claims.
7. The US Military will be unable to provide Personnel Records and prior medical treatment and claim information.
The potential fiscal impact of a US debt crisis is enormous. Hopefully, the politicians in Washington will reach a compromise and the this crisis will be resolved and everyone can creatively focus on making the compensation system less complicated and more efficient.
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- Workers' Compensation Medicare Set-Aside Portal (WCMSAP) (workers-compensation.blogspot.com)
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Tuesday, April 2, 2013
CMS Hosting a Town Hall Event for WCMSA
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Saturday, October 26, 2013
Most Americans accumulating debt faster than they’re saving for retirement - The Washington Post
A majority of Americans with 401(k)-type savings accounts are accumulating debt faster than they are setting aside money for retirement, further undermining the nation’s troubled system for old-age saving, a new report has found.
Three in five workers with defined contribution accounts are “debt savers,” according to the report released Thursday, meaning their increasing mortgages, credit card balances and installment loans are outpacing the amount of money they are able to save for retirement. The imbalance is expanding even as policymakers are encouraging people to set aside more by offering generous tax breaks and automatically enrolling workers in retirement accounts that in some cases automatically escalate the amount of money over time. Currently, workers with retirement savings accounts put aside more than 11 percent of their pay for retirement — 5 percent in their own accounts, and 6.2 percent in Social Security. Despite that — and despite the $2.5 trillion the report says employers have poured into defined contribution accounts from 1992 to 2012 — the retirement readiness of most Americans has been slipping, according to the report by HelloWallet, a D.C. firm that offers technology-based financial advice to workers and conducts research of economic behavior. “Policy has tunnel vision. It tends to tackle problems on a piecemeal basis. The impact of policy on consumer finances is a bit like playing a game of... |
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Sunday, February 23, 2014
Detroit Files Financial Restructuring Plan
DETROIT—The city of Detroit submitted its financial restructuring plan to federal court Friday, a move likely to set off a new round of jockeying among creditors asked to take a haircut in the nation’s largest municipal bankruptcy.
The plan seeks to restructure an estimated $18 billion in long-term obligations by paying secured creditors in full, paying pension funds a reduced amount, and giving other unsecured creditors just a fraction—about 20 cents on the dollar—of the outstanding debt the city still owes.
“There is still much work in front of all of us to continue the recovery from a decadeslong downward spiral,” Detroit Emergency Manager Kevyn Orr said in a statement Friday. “We must move swiftly to emerge from bankruptcy so that the financial distress harming the City can end.”
As part of the plan, city officials said they would set aside $1.5 billion over 10 years for capital improvements, blight removal, and equipment and technology upgrades to make the city safer, cleaner and more efficient. Up to $500 million of that will be dedicated to blight removal over the next five years, officials said. Read the full WSJ story here.
Michigan Gov. Rick Snyder, who steered the city into a bankruptcy filing in July, called on many city creditors who have been reluctant to settle to reconsider.
“Let’s use this plan as a call to action for a voluntary settlement as part of the mediation process to resolve the...
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Read more about "Bankruptcy and Workers' Compensation"
Monday, March 30, 2009
Nationalizing Workers’ Compensation Medical Delivery
Recently the Obama Administration invited the medical insurance industry to the White House to discuss possible future scenarios on the delivery of health care. A planted floated at the meeting was one that President Obama advocated in h campaign. That proposal was allow the Federal government to sell health care coverage.
Tuesday, August 14, 2012
CMS Rules Out TENS Units for Low Back Pain
The Centers for Medicare and Medicaid (CMS) has issued a ruling that will impact on the payment of proceeds in Workers' Compensation Medicare Set Aside Agreements (WCMSA). CMS has ruled out the use of TENS (Transcutaneous Electrical Nerve Stimulation) units for the treatment of chronic low back pain.
"For those WC [workers' compensation]cases that were not settled prior to June 8, 2012, and where the WCMSAs proposal includes funding for TENS for CLBP [chronic low back pain] as part of the WCMSA, CMS will re-review the cases and remove pricing for TENS for CLBP. (Regional Offices shall obtain from submitters requests for a case re-review, along with a signed statement indicating a settlement had not occurred prior to June 8, 2012.)"
Case law throughout the country has been divided on whether TENS units should be authorized to cure and relieve low back pain.
Click here to read: Decision Memo for Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain (CAG-00429N)
Click here to read: Impact of the Removal of coverage of Transcutaneous Electrical Nerve
Stimulation (TENS) Units for Chronic Low Back Pain (CLBP) on Workers’ Compensation Medicare Set-Aide Arrangement (WCMSA) proposals – INFORMATION
.....
For over 3 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.
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Monday, June 17, 2013
Overpayment Of Unemployment Due To Payment of Workers’ Compensation Benefits – NOW WHAT?!?
- Notify the unemployment insurance system that they are continuing to seek payment from the workers’ compensation system, but that they are involved in an appropriate job search during the dispute process.
- Immediately share with the workers’ compensation attorney any notices or orders received from the unemployment insurance system. These are usually NOT mailed to the attorney of record in a workers’ compensation claim and the notices often have limited time periods within to file a protest or request for reconsideration of the determination.
- Hold in savings from the workers’ compensation payment the claimed unemployment overpayment amount during the dispute process until a final overpayment notice has been issued, or have the workers’ compensation attorney hold this amount in their trust account. If this is not possible, be prepared to enter into a repayment agreement with the unemployment insurance system once a final overpayment figure has been determined.
- Seek assistance from the workers’ compensation attorney to document all attorney fees and costs paid as part of the effort to obtain back benefits under the workers’ compensation claim. Submit this documentation to the unemployment insurance system and request a reduction in the claimed overpayment to take these attorney fees and costs into account.
- Continue to send any notices or orders to the workers’ compensation attorney.
- Once the overpayment has been repaid, check to see if the receipt of workers’ compensation back benefits changes your tax obligations. In many states, workers’ compensation payments are not taxable income, but unemployment benefits are taxable. If there is a significant payment of back benefits under the workers’ compensation claim, it may be worthwhile to file an amended tax return with the IRS to document the lower taxable income figure.
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Thursday, September 4, 2014
J&J’s Pinnacle Hips Face First Trial on Poisoned Patients
Johnson & Johnson (JNJ), which set aside $2.5 billion last year to resolve claims that 8,000 of its artificial hips were defective, faces a new round of lawsuits over another line of hip implants blamed for poisoning patients.
J&J’s DePuy unit is starting its first trial of allegations that the metal-on-metal version of the Pinnacle hip was defectively designed and caused metal debris to leech into patients’ bloodstreams. The cobalt-and-chromium material caused an infection that forced Kathleen Herlihy-Paoli to have her artificial hips surgically removed, she said in court filings.
Jury selection began today in Herlihy-Paoli’s suit, the first of more than 6,000 cases over the devices to be weighed by a jury. The cases have been consolidated before U.S. District Judge Ed Kinkeade in Dallas for pretrial information exchanges. Kinkeade will preside over Herlihy-Paoli’s trial.
“The first trials in any of these consolidated litigations set the tone for the following cases,” Carl Tobias, who teaches product-liability law at the University of Richmond in Virginia, said in an interview. “If J&J loses the first couple of these Pinnacle trials, they better start seriously thinking about coming up with a settlement similar to what they signed off on for the ASR hips.”
Ultamet Line
J&J said studies have shown the Pinnacle Ultamet line of devices restores mobility and reduces pain for patients in need of hip replacement.
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Friday, September 5, 2014
BP May Be Fined Up to $18 Billion for Spill in Gulf
In the four years since the blowout on the Deepwater Horizon oil rig killed 11 workers and sent millions of barrels of oil gushing into the Gulf of Mexico, BP has spent more than $28 billion on damage claims and cleanup costs, pleaded guilty to criminal charges and emerged a shrunken giant.
But through it all, the company has maintained that it was not chiefly responsible for the accident, and that its contractors in the operation, Halliburton and Transocean, should shoulder as much, if not more, of the blame.
On Thursday, a federal judge here for the first time bluntly rejected those arguments, finding that BP was indeed the primary culprit and that only it had acted with “conscious disregard of known risks.” He added that BP’s “conduct was reckless.”
By finding that BP was, in legal parlance, grossly negligent in the disaster, and not merely negligent, United States District Court Judge Carl J. Barbier opened the possibility of $18 billion in new civil penalties for BP, nearly quadruple the maximum Clean Water Act penalty for simple negligence and far more than the $3.5 billion the company has set aside.The ruling stands as a milestone in environmental law given that this was the biggest offshore oil spill in American history, legal experts said, and serves as a warning for the oil companies that continue to drill in the deep waters of the Gulf of Mexico, where high pressures and temperatures in the wells test the most...
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Tuesday, December 17, 2013
Firms to pay $1.1-billion in long-running lead paint lawsuit
A Northern California judge Monday ordered three companies to pay $1.1 billion to remove lead-based paint from inside California homes, concluding a 13-year legal case.
Santa Clara County Superior Court Judge James P. Kleinberg ruled that ConAgra, NL Industries and Sherwin-Williams created a “public nuisance” by selling lead-based paint for decades before it was banned in 1978, finding them liable for exposing children to a known poison.
The opinion set aside $605 million, or 55% of the judgment, to pay for lead removal in Los Angeles County. The money will go into a fund administered by the state’s Childhood Lead Poisoning Prevention Branch and will pay for inspections and lead abatement on the inside walls of tens of thousands of homes.
“The court is convinced there are thousands of California children in the Jurisdictions whose lives can be improved, if not saved through a lead abatement plan,” the judge’s ruling said.
Local governments sued major paint manufacturers in 2000,...
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Click here to read the complete Decision. People v. Atlantic Richfield Company, et al.
Superior Court of California, County of Santa Clara
Case No. 1-00-CV-788657
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