Settlement News

Settlement News is NuQuest/Bridge Pointe's regularly published newsletter, dedicated to keeping you appraised of key developments in MSP Compliance, and outlining practical options to consider in addressing Medicare issues in relation to day to day claims handling.

July '11

The issue of what obligations primary payers and other parties may have to reimburse Medicare Advantage (MA) plans is a topic that is currently generating considerable interest in the claims industry.
 
Over the past few months, this topic has also been the subject of several important court rulings, including the recent decision in the case In Re Avandia Marketing, Sales Practices and Products Liability Litigation, Nos. 7-md-01871, 10-6733, 2011 WL 2413488 (D. Pa., June 13, 2011). 

This Edition of NuQuest/Bridge Pointe’s Settlement News provides important background information regarding MA plans and examines recent court decisions addressing the secondary payer status of MA plans.

June '11

Wilson v. State Farm
This Edition of NuQuest/Bridge Pointe’s Settlement News outlines and examines the court’s decision in the Wilson v. State Farm case.In this uninsured motorist claim, the court ruled that an insurance carrier did not violate Kentucky’s “bad faith” law by delaying payment of a settlement pending its determination of Medicare’s reimbursable conditional payment amount.  The Wilson decision will likely be viewed favorably by primary payers in regard to their efforts to comply with the MSP and protect themselves from potential liability. 
 

March '11

On March 14, 2011, the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act) (H.R. 1063) was introduced in the U.S. House of Representatives. The SMART Act proposes major amendments to the Medicare Secondary Payer Statute (MSP).  the SMART Act's reform proposals target the following areas of MSP complianc

  • Obtaining CMS’ reimbursable conditional payment amount;
  • Requiring CMS to respond  to requests  for conditional payment information within set timelines;
  • MSP appeal rights;
  • Section 111’s “$1,000 a day, per claim” penalty provision;
  • Use of Claimant’s SSNs and HICNs;
  • MSP threshold exemptions; and
  • MSP statute of limitations.

This Edition of NuQuest/Bridge Pointe’s Settlement News outlines the proposals contained in the SMART Act and discusses how they relate to MSP compliance.

February '11

CMS is on record clearly stating that its WC-MSA review thresholds are not “safe harbors” and that its interests must always be considered when settling any WC case – even if the settlement does not technically meet the review thresholds.

Unfortunately, CMS has not really provided much guidance regarding when, or how, it expects the industry to protect its interests in “non-threshold” cases.  As a result, the perplexing and troubling question of “What should I do if my case does not meet CMS’ WC-MSA review thresholds?” remains almost a decade into CMS’ MSA process. With CMS continuing to tighten its compliance grip on the claims industry, many primary payers and practitioners are re-examining their compliance practices to determine how best to address Medicare’s interest in non-threshold cases.

This Edition of Settlement News places the convoluted issue of Medicare compliance in non-threshold WC cases into proper perspective and outlines practical approaches for consideration.   

October '10

In U.S. v. Stricker, the Federal Government sued several plaintiff lawyers, plaintiff law firms, corporations and insurance carriers, for their alleged failure to reimburse Medicare for conditional payments arising out of a large toxic tort liability settlement reached in 2003. The Government was seeking reimbursement of Medicare conditional payments (plus interest), double damages against the primary payers and other legal relief.

In an important legal ruling, on September 30, 2010 the United States District Court for the Northern District of Alabama dismissed the Government’s action against certain named defendants on statute of limitations grounds.  That is, the Court found that the Government failed to file its action in a timely manner.

The October edition of Settlement News breaks down and examines this important Court ruling as follows:

  • How the U.S. v. Stricker Case Arose
  • The Basis for the Government’s Action
  • Overview of Key MSP Statutes and Regulations Regarding Medicare Conditional Payments
  • Why the Court Dismissed the Government’s Action
  • Understanding the Basis of the Court’s Ruling
  • Assessing U.S. v. Stricker and the Court’s Ruling in the Bigger Picture of MSP Compliance

June '10

On May 19, 2010, the Centers for Medicare & Medicaid Services (CMS) released a new policy memorandum dated May 14, 2010 addressing the separate issues of (a) off label and/or unlabeled outpatient drug uses and (b) rated ages in relation to the agency’s Workers’ Compensation Medicare Set-Aside (MSA) program.

Through the May Memo, CMS sets forth new guidelines regarding when off label and/or unlabeled drugs are covered by Medicare Part D and, thus, includable as part of a workers’ compensation MSA proposal. In addition, CMS has rescinded its previous rated age policy and announced that the MSA submitter will now need to include a very specific rated age “certification statement.”

The June 2010 edition of Settlement News analyzes CMS’ new policies and assesses their potential impact on the MSA process.

December '09

CMS’ enactment of new policies for calculating future Medicare Part D prescription drug costs for MSA proposals in workers’ compensation cases is perhaps the most significant development on the MSA front in the past few years.

These new policies are currently resulting in alarming and unprecedented increases in required MSA amounts. In turn, this is causing considerable problems for claims handling and settlement on a number of levels.

CMS’ new policies have fundamentally changed the landscape and introduced an added layer of complexity to claims handling and settlement.  Now is the time for all claims handlers and practitioners to assure that they have a firm understanding of CMS’ new policies and how the policies are impacting claims handling and settlement practices. 

This edition of Settlement News places the issue into proper focus to assist claims professionals and practitioners in addressing the problem as follows:

  • CMS’ Prior Approach to RX Drugs (1/1/06 to 6/1/09)
    Understanding the Prior Landscape - Where We Have Been
     
  • CMS’ New RX Drug Policies for MSAs (6/1/09 to Present)
    Recognizing & Navigating the New Terrain – Where We Are Now
     
  • Practical Considerations for Claims Handling & Settlement
    What Can I Do to Address the Issue?

July '08

The July edition of Settlement News takes an in depth look at MSA Account Self Administration and why so many claimants are failing to properly administer accounts.  The newsletter provides helpful insights regarding:

  • The requirements for MSA self administration
  • Some of the most difficult challenges facing self administering claimants; and
  • Practical steps that can be utilized to optimize successful self administration

June '08

This edition of Settlement News addresses several pertinent areas affecting liability primary payers, including the following:

  • Obligations of liability primary payers under the MSP
  • The impact of the forthcoming requirements under Senate Bill 2499
  • Considering Medicare's "future interests" in liability cases - Are MSAs applicable in liability settlements?
  • A review of the MSA in the Workers' Compensation arena to help better understand the issue from the liability side
  • Practical options to address the issue of Medicare's "future interests" in liability cases