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…

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MASSIVE Completely Resolves Medicare Lien for Connecticut Plaintiff

A Connecticut man received a delayed diagnosis of parotid cancer. This is an aggressive form of cancer and can be terminal. However, if caught early, life expectancy can be prolonged with early intervention.   MASSIVE’s experts established that the treatment on his lien was medically necessary for the plaintiff’s cancer care and would have occurred…

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The New Rules of MSAs

How Defense Uses Non-Submit MSAs

Medicare Set-Asides (“MSAs”) don’t exist under the law. CMS insists MSAs are a voluntary process. But – are they truly voluntary?   CMS’s recently updated WCMSA User Guide has a new section 4.3 that makes it seem like MSAs are essentially mandatory. The good news is that CMS has laid out all of the reasons…

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Avoiding 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…

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What 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…

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Medicare 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…

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Medicare 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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