Breaking: CMS Recovery Practice Ruled Improper under the MSP

In an important new case—CIGA v. Burwell, 2017 WL 58821 (C.D. California, January 5, 2017)—the court ruled that the CMS practice of seeking full reimbursement of a medical provider’s single charge—even where some unsegregated portion of that charge relates to services not covered by a workers compensation plan—was improper under the Medicare Secondary Payer Statute […]

Scrooge & Marley, PLC: A commercial insurance case study

Scrooge

Scrooge & Marley, PLC, was a privately held partnership in 19th-century England that operated out of a dingy warehouse in the Cornhill section of London. Partners Ebenezer Scrooge and Jacob Marley founded the “counting house” with no outside investors or small business loans. Marley referred to the firm as “a money-changing hole,” a closely held, […]

The Insurable Risks of Zombie Attacks on Small Businesses

zombies

Zombies are sweeping the nation—at least if you believe the media and pop culturists. The walking dead are everywhere, from cities and small towns to homes and offices. While most people try to eradicate them, few are learning to adapt and deal with the situation. Case in point: For every time you’ve seen zombies creating […]

Will CMS Expand MSA Reviews to Liability Cases and Other Claims?

Mark Popolizio

On June 9, the Centers for Medicare and Medicaid Services (CMS) announced that it is considering expanding its voluntary Medicare Set-Aside (MSA) review process to include liability insurance (including self-insurance) and no-fault insurance claims. While CMS didn’t provide details, it plans to work closely with stakeholders to determine “how best to implement this potential expansion.” […]

Liability or Workers Comp? Federal Employment Acts and the MSP

When it comes to Medicare Secondary Payer (MSP) compliance, we usually make a distinction between workers compensation and liability insurance claims. Different elements of MSP compliance come into effect depending on the insurance-type classification. Sometimes certain insurance categories can cause confusion. For example, the Longshore and Harbor Workers’ Compensation Act (LHWCA), which covers more than […]

Solving a problem before it’s a problem

Image1

Insurance trades, blogs, and websites devote a great deal of space to addressing two critical issues related to the risks associated with writing workers compensation policies: claims costs and medical fraud. Claimants may exaggerate their symptoms, file a non-work-related injury as a work-related injury, or falsify other material issues. On the treatment side, doctors, rehabilitation […]