CMS Issues Final Rule Establishing Conditional Payment Appeals Process Pursuant to the SMART Act

We previously had posted a blog that CMS had issued a proposed rulemaking regarding an appeals process to be utilized by applicable plans for conditional payment disputes. For background on the rulemaking and to view our prior blog, please click here. Today, CMS issued a final rule implementing provisions of the Strengthening Medicare and Repaying … Read moreCMS Issues Final Rule Establishing Conditional Payment Appeals Process Pursuant to the SMART Act

Louisiana Appellate Court Agrees Claimant Committed Fraud, Forfeits All Future Benefits, Including Medicare Set Aside Annual Structured Funds

On December 23, 2014, the Louisiana Court of Appeal, 1st Circuit, published its opinion on Shropshire v. Anco Installation, finding that because claimant deliberately misrepresented the facts of his settlement negotiations for the purpose of obtaining additional benefits, all workers’ compensation benefits, including future settlement monies and Medicare set aside funds, are forfeited. Mr. Shropshire … Read moreLouisiana Appellate Court Agrees Claimant Committed Fraud, Forfeits All Future Benefits, Including Medicare Set Aside Annual Structured Funds

CMS Publishes Self Administration Toolkit for WC Medicare Set Asides

On March 21, 2014, CMS published its first Self Administration Toolkit for Workers Compensation Medicare Set Aside Arrangements (WCMSA). CMS had previously provided significant leadership on WCMSA administration matters through the several Policy Memos and Reference Guide it had published over the preceding 14 years. However, this was their first attempt at focusing on self … Read moreCMS Publishes Self Administration Toolkit for WC Medicare Set Asides

Louisiana Appellate Court Sets Aside Settlement Based on Confusion Over MSA

On October 27, 2014, the Louisiana Court of Appeal, First Circuit, published its opinion on McCarroll v. Livingston Parrish Council and Louisiana Workers Compensation Corporation, concluding that since all parties believed that the MSA amount could be used to pay for Mr. McCarroll’s surgery and that Medicare would pay for the surgical costs exceeding the … Read moreLouisiana Appellate Court Sets Aside Settlement Based on Confusion Over MSA