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CMS Guidance on WCMSA’s Section 4.3
We like to remind the legal industry that Medicare Set-Asides (“MSAs”) don’t exist under the law. They’re a very good idea considering the consequences to a claimant or plaintiff of not having an MSA. Remember that CMS’s recent update to the WCMSA User Guide has a new section 4.3 with CMS warning us of…
Read MoreSpecial Challenges in Managing Large Mass Tort Cases
Mass tort lien resolution can be an extensive process; however, you or the lien resolution administrator can take some significant steps to reduce the challenge. To start, you want to be prepared and get started early. Before the claims administrator approves allocations for each plaintiff, the lien resolution administrator can establish global resolution programs…
Read MoreAvoiding Multiple and Duplicate Medicare Files
Medicare can and will open multiple files for a plaintiff’s motor vehicle accident case or workers’ compensation case. In those scenarios, that process is usually correct. In turn, Medicare might open multiple files for a plaintiff’s medical malpractice or other liability case. In this scenario, we think Medicare’s file is probably a duplicate. How do…
Read MoreMASSIVE: The Exclusive Lien Resolution Administrator for Purdue Opioid Trust
MASSIVE is proud to be the exclusive Lien Resolution Administrator for the Purdue Opioid Trust. While there is a delay in that Trust due to appeals, we are forging ahead with planning. What is the process for up to 150,000 claimants going to look like? Medicare Lien Resolution The United States Department of Justice…
Read MoreDoes an Insurance Company Automatically Have a Lien?
Subrogation rights are rarely absolute. But the process can be convoluted as you figure out whether federal law or state law governs your case’s health insurance liens. From Medicare to private liens here are some of the potential scenarios: Medicare → Federal law; Medicaid → State law (that is directed by a federal law in…
Read MoreState Law and Plan Language: What to Look for in Lien Resolution
Lien resolution starts with either a series of laws (like Medicare liens and Medicaid liens) or relies on plan language (like Private liens, ERISA liens, and more). For private liens, there are tens of thousands of different plans based on different state laws and different contracts – or plan language. If you know how…
Read MoreWhat is a “Non-Submit” or “Evidence-Based” MSA?
Medicare Set-Asides are a specialized product where Medicare has set forth a special process. The general idea is that an MSA will pay for medical care related to sued-for injuries so that Medicare doesn’t pay. But what happens when the MSA industry decides it wants to cut Medicare from the approval process? Medicare says…
Read MoreAnti-Subrogation: When Health Insurance has no Lien Right
Subrogation rights can be limited by state law. In fact, eight states are considered “Anti-Subrogation” states with one more effectively anti-subrogation. Those states are: Arizona Connecticut Kansas Missouri New Jersey New York North Carolina Virginia Georgia* – essentially anti-subrogation through a strong made whole doctrine that cannot be overridden by contract language Most simply,…
Read MoreMedicare Suggests LMSAs and NFMSAs are on the Horizon. Again.
Medicare via HHS/CMS has once again put us on notice that Medicare Set-Asides may expand to liability and no-fault scenarios with LMSAs and NFMSAs. It recently released a Notice of Proposed Rule Making with a due date of February 2022. You can find the NPRM here. Could that mean CMS will finally create rules…
Read MoreMedicare Set-Aside Basics
Medicare Set-Asides (or “MSAs”) are a construct created because the Medicare Secondary Payer Act makes it illegal for Medicare to pay for case-related treatment. Of course, this is limited to circumstances where a primary payer exists, such as a Workers’ Compensation carrier, a No-Fault carrier, or a liability defendant. But MSAs don’t exist under the law. They…
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