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Jumat, 06 Januari 2012

Baby Boomers Have Work Comp Claims Too

A recent study confirms that Baby Boomers are unfortunately not claiming workers' compensation benefits at a higher rate than younger workers. What the report doesn't reveal is that older disabled workers are being shifted to the Social Security system for medical benefits at a higher rate than ever before.

NCCI, with its private data, seems to ignore the fact that cost shifting is still occurring from workers' compensation insurance coverage to the general taxpayer by the utilization of Medicare. Until CMS finally shuts the door once and for all, older workers are going to take the easier path for benefits through Medicare. Medicare leaves the choice of doctors and the number of physicians to the patient.

At this point in time, the few senior workers who do file compensation claims for injuries superimposed on general deteriorating medical conditions, are being denied work comp due to pre-existing conditions and age related deterioration. It "used to be" that workers' compensation "took the worker as they found him (her)," but that has changed through the insurance company initiated legislative efforts in a majority of jurisdictions.

Until such time as the workers' compensation system becomes user friendly to senior workers, those workers will be left out of the compensation system and will not realize the additional benefits of temporary and permanent partial or total disability benefits. Under the current system the senior workers, and the general taxpayer, are the big losers. The system needs to be reversed so that workers' compensation becomes a winning solution to the problem.

Read more about the baby boomers who are working: In a Second Career, Working to Make a Difference
“The concept of retirement is fading,” said Mary S. Bleiberg, ReServe’s executive director. “There is a steady increase in people over 65 going into or staying in the workforce. People are realizing they’re going to be around a lot longer, and there’s a limited number of golf clubs they can swing.”
Related articles

Selasa, 03 Januari 2012

Annual Reporting of WCMSA Account Expenditures

Address for submitting annual accounting documentation to CMS' Medicare Secondary Payer Recovery Contractor (MSPRC). Please send your completed annual Workers' Compensation Medicare Set-aside Arrangement (WCMSA) Account Expenditure accounting documentation to the CMS lead Medicare Contractor at the address below:

MSPRC - Non-Group Health Plan (NGHP)
P.O. Box 138832
Oklahoma City, OK 73113

Kamis, 08 Desember 2011

The Workers' Compensation Medicare Set-aside Portal (WCMSAP)

The Workers' Compensation Medicare Set-aside Portal (WCMSAP) application has gone "live" and is now available for users. Prior to attempting to register, you should read the New Registration section of the User guide. The URL for the WCMSAP may be found under the "Related Links Outside CMS," on the WCMSAP section page. The WCMSAP User Guide may be found in the "Reference Material" section of the WCMSAP application.

Instructions on how to register for the Computer Based Training (CBTs) may be found in the "Workers' Compensation Medicare Set-aside Portal (WCMSAP) Computer Based Training (CBT) document under the "Downloads Links" on the WCMSAP section page (click the "How to Register for WCMSAP Computer Based Training (CBT) Modules hyperlink.") These courses are designed to assist submitters of Workers' Compensation Medicare Set-Aside Arrangements (WCMSAs) with the registration and use of the WCMSAP.

How to Register For WCMSAP Computer Based Training (CBT) Modules (PDF, 117 KB)

This site provides an interface for entry of Workers' Compensation Medicare Set-Aside Arrangements (WCMSA) proposals. Attorneys, Medicare beneficiaries, claimants, insurance carriers and WCMSA vendors may use this site to enter the case information directly. The site also provides attorneys, Medicare beneficiaries, claimants, insurance carriers, and WCMSA vendors with the ability to track their submitted cases and the statuses without inquiry to the Coordination of Benefits Contractor (COBC) or the Centers for Medicare & Medicaid Services (CMS).

Senin, 05 Desember 2011

US Supreme Court Maybe Asked to Rule on CMS Issue: "The Doctrine of Equitable Allocation"

The 6th Circuit Court of Appeals has ruled that The Center for Medicare and Medicaid Services (CMS) is entitled to complete reimbursement of Medicare payments under the Medicare Secondary Payer Act (MSP) from a liability claim even though the beneficiary claimed that the settlement required allocation due to the law allocating liability.

I reported on this case last week:
The Doctrine of Equitable Allocation Not Applicable in a Medicare Secondary Payment Reimbursement Claim

A recent news report indicates that appeal maybe sought to the US Supreme Court.

Medicare payment ruling may hinder workers comp settlements

"A federal appeals court decision that allows Medicare to claim nearly half of a man's liability settlement could hinder insurers' ability to settle such claims and may be an issue that reaches the U.S. Supreme Court."

read more:

Selasa, 22 November 2011

CMS Sets Telephone Conference Call to Discuss Workers' Compensation Medicare Set-aside Portal

The Centers for Medicare & Medicaid Services (CMS) has completed its Pilot Testing of the Workers' Compensation Medicare Set-aside Portal (WCMSAP). The CMS will be conducting a Town Hall conference call on November 29, 2011 from 1:00 to 3:00 pm (EST), to introduce this initiative to submitters of proposed Workers' Compensation Medicare Set-Aside Arrangement (WCMSAs) amounts, and to answer questions regarding the WCMSAP. After the Town Hall conference call, CMS will post the links of the WCMSAP application, and the WCMSAP Computer Base Training (CBT) Modules, on the Workers' Compensation Medicare Set-aside Portal (WCMSAP) section page "Related Links Outside CMS."

Please Note: The call in information for the WCMSAP Town Hall teleconference is:
Call in time: 1pm to 3pm
Call In Line: 1-(800) 603-1774
*Conference ID: 29840615

*Participants must use the Conference ID number to be allowed into the call.

The Doctrine of Equitable Allocation Not Applicable in a Medicare Secondary Payment Reimbursement Claim

The 6th Circuit Court of Appeals has ruled that The Center for Medicare and Medicaid Services (CMS) is entitle to complete reimbursement of Medicare payments under the Medicare Secondary Payer Act (MSP) from a liability claim even though the beneficiary claimed that the settlement required allocation due to the law allocating liability.

"We address only one of them here: specifically, under § 1395y(b)(2)(B)(ii) as amended, if a beneficiary makes a “claim against [a] primary plan[,]” and later receives a “payment” from the plan in return for a “release” as to that claim, then the plan is deemed “responsib [le]” for payment of the “items or services included in” the claim. Id. Consequently, the scope of the plan's “responsibility” for the beneficiary's medical expenses—and thus of his own obligation to reimburse Medicare-is ultimately defined by the scope of his own claim against the third party. That is true even if the beneficiary later “compromise[s]” as to the amount owed on the claim, and even if the third party never admits liability. And thus a beneficiary cannot tell a third party that it is responsible for all of his medical expenses, on the one hand, and later tell Medicare that the same party was responsible for only 10% of them, on the other."

Hadden v. U.S., --- F.3d ----, 2011 WL 5828931, C.A.6 (Ky.), 2011. Decided November 21, 2011.

For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Sabtu, 22 Oktober 2011

Government Appeals Case Involving MSP Statute of Limitations

A Notice of Appeal has been filed by the United States in a case where a Federal District Court held that the statute of limitations in a Medicare Secondary Payer Act recovery action was limited to only 6 years. The government contented in the matter that the statute of limitations for it to assert recovery/reimbursement was extended under the "implied contract theory."

The case was tried in the U.S. District Court, Northern District of Alabama (Eastern) before Judge Karon O. Bowdre and involved a contract reimbursement claim under the Medicare Act, specifically 425 USC 1395 (HHS). A Final Order was entered on September 13, 2011 the the United States filed a Notice of Appeal on October 11, 2011.

Read the prior posting: CMS Has 6 Year Statute of Limitations-Court Dismisses MSP Recovery Claim 10.1.2010

United States of America v James J. Stricker, et al., CV 09-BE-2423-E (USDCT ND Alabama)

Kamis, 20 Oktober 2011

Social Security 2012: The Good News and The Bad News

The good news is the announcement by Social Security that the rate of payment will increase 3.6% The bad news that Part B Medicare premiums will offset the payment.

Monthly Social Security and Supplemental Security Income (SSI) benefits for more than 60 million Americans will increase 3.6 percent in 2012.

The 3.6 percent cost-of-living adjustment (COLA) will begin with benefits that nearly 55 million Social Security beneficiaries receive in January 2012. Increased payments to more than 8 million SSI beneficiaries will begin on December 30, 2011.

The Social Security Administration also noted that for some beneficiaries, the increase in Social Security benefits next year “may be partially or completely offset by increases in Medicare premiums.”

For an in depth analysis read the NY Times article.

Click here for PBS News Hour coverage.

Jumat, 14 Oktober 2011

Florida, Oxycodone Trafficking, Workers Compensation and Blame

The announcement by the US Attorney in Florida of the indictment today of 24 individuals for trafficking Oyxcodone puts a cloud over the claims that the workers compensation system is to blame. With the alleged bad apples caught, the announcement should refocus concern not on the work comp system, but rather on those outsiders who attempt to prey on it for personal gain.

If anything, the system needs more safeguards to protect both the injured workers as well as the taxpayers. Pending legislation in Florida that restricts prescribed medications in workers' compensation claims only emasculates the social remedial benefit program further forcing the disabled to seek help outside the system. Why blame the victims and punish them.

"Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Mark R. Trouville, Special Agent in Charge, Drug Enforcement Administration (DEA), Christopher B. Dennis, Special Agent in Charge, Health and Human Services, Office of Inspector General (HHS-OIG), José A. Gonzalez, IRS Special Agent in Charge, Director James K. Loftus, Miami-Dade Police Department, Al Lamberti, Sheriff, Broward Sheriff’s Office, and H. Frank Farmer, M.D., State Surgeon General, Florida Department of Health (DOH), announced the unsealing of a federal indictment charging twenty four defendants for their participation in, among other things, conspiracy to distribute oxycodone and oxymorphone, and conspiracy to defraud Medicare. Twenty-one of the defendants, including a doctor, a pharmacist and two pain clinic operators are currently in custody after a multi-agency takedown was executed early this morning. Three defendants, Hattie Mae Green, Eliezer Salgado and Ronald Regains, remain at large.

Researchers from the Centers for Disease Control and Prevention report that Schedule II prescription painkillers, like oxycodone, today cause more drug overdose deaths than cocaine and heroin combined. Oxycodone and other Schedule II drugs have a high potential for abuse and can be crushed and snorted, or dissolved and injected, to get an immediate high. This abuse can lead to addiction, overdose, and sometimes death.

The nine-count indictment, filed on September 30, 2011 and unsealed today, charges all defendants with conspiracy to possess with intent to distribute controlled substances, namely oxycodone and oxymorphone (Count 1), and conspiracy to commit health care fraud (Count 9). Several of the defendants also face substantive charges of possession with intent to distribute controlled substances (Counts 2-6, 8), and attempted possession of controlled substances (Count 7).

Charged in the indictment are Aiman Izzedin Aryan, 40, of Pinecrest, Emerson Carmona, 40, of Miami,Frank J. Ballesteros, M.D., 57, of Miami, Gerardo Gomez, 38, of Miami, Juan De Dios Gomez, 40, of Miami, Danay C. Manso, 22, of Miami, Danilo Falcon, 38 of Miami, Eliezer Salgado, 29, of Hialeah,Francisco Hernandez, 57, of Miami, Leroy Paige, 49, of Madison, Alyssa Lyn Paige, 32, of Madison,Cynthia Suzette Adderley, 53, of Ft. Pierce, Victor D. Alexander, 50, of Ft. Lauderdale, Aaron Lamar Allen, 44, of Ft. Lauderdale, Henry Louis Conley, Jr., 53, of Miami, Hattie Mae Green, 53, of Miami,Petronella Smith Howard, 52, of Ft. Pierce, Eric Fyke Miller, 42, of Ft. Lauderdale, Annie Mims Simmons, 72, of Miami, Bobbie Lee Anderson, 58, of Gifford, Denise Darcelle Dardy, 48, of Miami, Margaret Marie Elliott, 54, of Ft. Pierce, Billy Joe McCoy, 53,of Ft. Pierce, and Ronald Regains, 56, of Ft. Lauderdale.

U.S. Attorney Wifredo Ferrer stated, “According to recent estimates, Florida prescribes ten times more oxycodone pills than all other states combined. Each day, individuals die from prescription drug overdoses. To stop this drug epidemic, we have previously charged clinic owners, operators, and doctors who deal drugs while hiding behind a medical license. Today, we have focused our efforts on those pharmacies who are churning out pills that are fraudulently prescribed at area pain clinics. We will continue to tackle South Florida’s pill mill epidemic from all angles and at all levels to eradicate these drug dealing organizations.”

DEA Special Agent in Charge Mark R. Trouville said, “The Drug Enforcement Administration continues its relentless attack on those who supply the prescription drug epidemic in our country, state, and local communities. With today’s arrests, twenty four people will no longer add to this drug problem.”

“Today’s multi-agency operation makes clear that drug trafficking and health care fraud make for a vile combination that simply cannot be tolerated,” said Christopher B. Dennis, Special Agent in Charge for the HHS-OIG region based in Miami. “Schemes to steal from taxpayers to pay for highly addictive, highly profitable street drugs , as the government alleges in this case, will trigger investigation and prosecution.”

“The Internal Revenue Service will continue to provide its financial investigative expertise to further the prosecution of criminals, especially those involved in complex financial schemes,” said IRS Special Agent in Charge Jose Gonzalez.

“The trafficking of oxycodone and oxymorphone has seeped into our community and extends beyond the borders of Miami-Dade County. We stand committed to working with our state and federal partners in the ongoing effort to apprehend these drug dealers who are destroying lives with their criminal behavior,” said Miami-Dade Police Department Director James K. Loftus.

“Through operations like this one, prescription drug peddlers are getting the message that pill pushing is no longer tolerated in Florida,” Broward Sheriff Al Lamberti said. “Federal and local enforcement efforts have turned the tide but we need to keep up the good work.”

“The Florida Department of Health has been diligently working with our law enforcement partners to identify unscrupulous practitioners who are inappropriately prescribing controlled substances,” stated Florida Surgeon General Dr. Frank Farmer. “When DOH learns that a practitioner is not following the law, we suspend that practitioners license. We will aggressively continue to fight the prescription drug problem in Florida.”

According to the indictment, from as early as November 2007 September 2011, defendants Gerardo Gomez, Juan De Dios Gomez, and Danay C. Manso operated and utilized pain clinics in Miami-Dade and Broward Counties. These pain clinics housed physicians, including defendant Frank J. Ballesteros, M.D., who would fraudulently prescribe oxycodone and oxymorphone for co-conspirator beneficiaries of Medicare and other prescription drug insurance plans. The beneficiaries would then present the fraudulent prescriptions obtained from the Gomezes’ pain clinics at complicit pharmacies operated by defendants Aiman Izzedin Aryan and Emerson Carmona. Once the prescriptions were filled, Aryan and Carmona would bill Medicare, and other insurers, for the cost of the prescriptions, knowing that the drugs were medically unnecessary and were being re-sold by the beneficiaries.

Defendants Leroy Paige, Alyssa Lyn Paige, Cynthia Suzette Adderley, Victor D. Alexander, Aaron Lamar Allen, Henry Louis Conley, Jr., Hattie Mae Green, Petronella Smith Howard, Eric Fyke Miller, and Annie Mims Simmons facilitated the drug-trafficking and health care fraud conspiracies by recruiting the corrupt health insurance beneficiaries to visit the Gomezes’ pain clinics and Dr. Ballesteros. Often, these recruiter defendants further participated by transporting the beneficiaries to the pain clinics to obtain the prescriptions and then to the pharmacies where they were filled. At the pharmacies, these defendants would receive and take control of the drugs from the beneficiaries. Once these defendants had the drugs, they would distribute them to Gerardo Gomez, Juan De Dios Gomez, Danilo Falcon, and Eliezer Salgado.

Defendants Bobbie Lee Anderson, Denise Darcelle Dardy, Margaret Marie Elliott, Billy Joe McCoy, and Ronald Regains were beneficiaries who posed as patients to obtain the fraudulent prescriptions for oxycodone and oxymorphone, which they then sold.

The indictment contains a forfeiture allegation seeking approximately $40,000,000 which is listed as the amount of proceeds derived by the defendants from the drug trafficking offenses charged in Counts 1 to 8 of the indictment.

If convicted, the defendants face a statutory maximum penalty of 20 years in prison on Counts 1 to 8, and a statutory maximum penalty of 10 years in prison on Count 9.

Today’s case, named Operation Gotham, is the result of the ongoing efforts by the Organized Crime Drug Enforcement Task Force (OCDETF), a partnership between federal, state and local law enforcement agencies. The OCDETF mission is to identify, investigate, and prosecute high level members of drug trafficking enterprises, bringing together the combined expertise and unique abilities of federal, state and local law enforcement.

Mr. Ferrer commended the DEA, the HHS-OIG, the IRS, the Miami-Dade Police Department, the Broward Sheriff’s Office, and the Florida Department of Health, for their work on Operation Gotham. This case is being prosecuted by Assistant U.S. Attorney Dwayne E. Williams.

An indictment is only an accusation and the defendants are presumed innocent until proven guilty.

Attachments:
Indictment (PDF)
A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida athttp://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.

Kamis, 06 Oktober 2011

Surgery Common for Medicare Patients in Final Year of Life

"Of the 1.8 million Medicare patients who died in 2008, about one-third underwent a surgical procedure the year before their death, according to a new study published online in The Lancet. More than 18% underwent a procedure in the last month of life.

Primary source: The Lancet
Source reference:
Kwok A, et al "The intensity and variation of surgical care at the end of life: a retrospective cohort study" Lancet 2011; DOI:
10.1016/S0140-6736(11)61268-3.

Sabtu, 01 Oktober 2011

New CMS Policy Announced: Asbestos Exposure, Ingestion, and Implantation Issues and December 5, 1980

The Centers for Medicare & Medicaid Services has consistently applied the Medicare Secondary Payer (MSP) provision for liability insurance (including self-insurance) effective 12/5/1980. As a matter of policy, Medicare does not assert a MSP liability insurance based recovery claim against settlements, judgments, awards, or other payments, where the date of incident (DOI) occurred before 12/5/1980.

When a case involves continued exposure to an environmental hazard, or continued ingestion of a particular substance, Medicare focuses on the date of last exposure or ingestion for purposes of determining whether the exposure or ingestion occurred on or after 12/5/1980. Similarly, in cases involving ruptured implants that allegedly led to a toxic exposure, the exposure guidance or date of last exposure is used. For non-ruptured implanted medical devices, Medicare focuses on the date the implant was removed. (Note: The term “exposure” refers to the claimant’s actual physical exposure to the alleged environmental toxin, not the defendant’s legal exposure to liability.)

In the following situations, Medicare will assert a recovery claim against settlements, judgments, awards, or other payments, and the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) Section 111 MSP mandatory reporting rules must be followed:

• Exposure, ingestion, or the alleged effects of an implant on or after 12/5/1980 is claimed, released, or effectively released.

• A specified length of exposure or ingestion is required in order for the claimant to obtain the settlement, judgment, award, or other payment, and the claimant’s date of first exposure plus the specified length of time in the settlement, judgment, award or other payment equals a date on or after 12/5/1980. This also applies to implanted medical devices.

• A requirement of the settlement, judgment, award, or other payment is that the claimant was exposed to, or ingested, a substance on or after 12/5/1980. This rule also applies if the settlement, judgment, award, or other payment depends on an implant that was never removed or was removed on or after 12/5/1980.

When ALL of the following criteria are met, Medicare will not assert a recovery claim against a liability insurance (including self-insurance) settlement, judgment, award, or other payment; and MMSEA Section 111 MSP reporting is not required. (Note: Where multiple defendants are involved, the claimant must meet all of these criteria for each individual defendant in order for a settlement, judgment, award, or other payment from that defendant to be exempt from a potential
MSP recovery claim and MMSEA Section 111 reporting):

•All exposure or ingestion ended, or the implant was removed before 12/5/1980; and

•Exposure, ingestion, or an implant on or after 12/5/1980 has not been claimed and/or specifically released; and,

•There is either no release for the exposure, ingestion, or an implant on or after 12/5/1980; or where there is such a release, it is a broad general release (rather than a specific release), which effectively releases exposure or ingestion on or after 12/5/1980. The rule also applies if the broad general release involves an implant.

For Specific Examples Click Here To Read the CMS Memo

REPORTING REMINDER:

Information related to the MMSEA Section 111 MSP reporting requirements can be found at
www.cms.hhs.gov/MandatoryInsRep. When reporting a potential settlement, judgment, award, or other payment related to exposure, ingestion, or implantation, the date of first exposure/date of first ingestion/date of implantation is the date that MUST be reported as the DOI. This is true for purposes of individual self-identification of a pending claim to the Centers for Medicare & Medicaid Services’ Coordination of Benefits Contractor, as well as for MMSEA Section 111 reporting.
Related articles

Jumat, 30 September 2011

CMS Announced Status Update and Future Changes

As part of the Centers for Medicare & Medicaid Service (CMS) efforts to continuously improve its Medicare Secondary Payer (MSP) program; CMS has posted the following information to the MSP websites:

1) An ALERT delaying the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) Section 111 MSP reporting requirement for certain liability insurance (including self-insurance) settlements, judgments, awards, or other payments is now posted at www.cms.gov/MandatoryInsRep.

2) Policy guidance related to Exposure, Ingestion, and Implantation issues, and December 5, 1980, is now posted at www.cms.gov/MandatoryInsRep and www.cms.gov/COBGeneralInformation.

3) An ALERT related to Qualified Settlement Funds, under Section 468B of the Internal Revenue Code, is now posted at www.cms.gov/MandatoryInsRep.

4) A policy memorandum, for liability insurance (including self-insurance), on the acceptance of the treating physician's certification, and its impact on the issue of protecting Medicare's interests with respect to future medicals is now posted at www.cms.gov/COBGeneralInformation.

In addition, on September 30, 2011, the MSPRC will implement a self-service information feature to its customer service line. This feature gives callers the ability to get the most up-to-date Demand/Conditional Payment amounts, and the dates that those letters were issued, without having to speak to a customer service representative. The self-service feature will be available for extended hours, and callers will have the option of requesting information on multiple cases during one phone call.

Beginning in October 2011, CMS will implement an option to pay a fixed percentage of certain physical trauma-based liability cases with settlement amounts of $5000 or less. Detailed information on this option will be posted as an ALERT, on or before October 21, 2011, on the MSPRC website at www.MSPRC.info.

Upcoming improvements to the MSP program, expected within the next 3-9 months, include the following:

• The implementation of a MSPRC portal, where the beneficiary/representative can obtain information about Medicare's claim payments, demand letters, etc., and input information related to a settlement, disputed claims, etc.

• The implementation of an option that allows for an immediate payment to Medicare for future medical costs that are claimed/released/effectively released in a settlement.

• The implementation of a process that provides Medicare's conditional payment amount, prior to settlement in certain situations.

Senin, 29 Agustus 2011

Pensions, Workers Compensation and Medical Benefits

The State of New Jersey has taken assertive action to guarantee medical benefits to injured workers for their lifetimes even though they are receiving accidental injury pensions. The Director has issued an Administrative Directive requiring language to literally toll the statute of limitations and permit the Division of Workers' Compensation to retain jurisdiction over such matters where the injured worker has accepted the continuing medical benefit option.

"Petitioner has been awarded and accepted an accidental disability pension effective _(date)_. To resolve the workers' compensation case, petitioner and respondent have agreed to provide petitioner with reasonable and necessary medical treatment for injuries related to the _(date)_ accident. This Order for continuing medical benefits shall not be subject to the two year statute of limitations and such medical benefits shall continue for the life of the petitioner or until further order of this court."

By statute, workers' compensation awards are offset by pension awards. The medical issue remains open usually and medical benefits remain the responsibility of the employer. The medical issue becomes a complication when costs are attempted to be shifted to collateral medical carriers or Medicare. The subsequent reimbursement issue then generates medical lien claims that must be litigated. The incorporation of the language will greatly clarify responsibility and expedite medical care and payment.

Rabu, 10 Agustus 2011

Qui Tam Action for MSP Results in Costs to Plaintiff

A Federal court ruled that a plaintiff acted with an improper purpose and in bad faith by filing seven different putative qui tam actions against various health care providers under the Medicare Secondary payer Act (MSP). The Federal Court imposed sanctions against plaintiff pursuant to court's inherent power.

The Court reasoned that there was no legal support for plaintiff's claim that MSP was a qui tam statute, Court of Appeals had previously determined that plaintiff's claims were “utterly frivolous” and “unreasonable and vexatious,” and plaintiff had already filed dozens of almost identical cases across the country with similar results.

Stalley ex rel. U.S. v. Mountain States Health Alliance, 644 F.3d 349, C.A.6 (Tenn.), 2011, decided July 08, 2011

Related articles

Senin, 08 Agustus 2011

Workers' Compensation Medicare Set-Aside Web Portal (WCMSAP) Webinar

Please read below an invitation to Submitters to attend a CMS Workers' Compensation Medicare Set-Aside Web Portal (WCMSAP) Webinar.

WCMSAP Submitters Webinar - August 10, 2011

Event Description: This Webinar will review the Workers' Compensation Medicare Set-Aside Portal (WCMSAP), a new web-based application that allows for the electronic submission and tracking of WCMSA proposals submitted to CMS for review. This Webinar will also review the current WCMSA proposal submission process, the new submission process on the WCMSAP and the WCMSAP screens that will be used to enter and submit a proposal.

Enrollment Information: To receive your Webinar access information simply send an email to Techi@nhassociates.net and include the following information. To ensure that you receive webinar access information, future notifications and announcements regarding the Webinar, please add this e-mail address (Techi@nhassociates.net) to your "Safe Sender" list in your e-mail client.

Note: Due to limited seating we will need to hold attendance to an 85 user maximum. So please reserve
your seat as soon as possible, we apologize for any inconvenience.

Information Required for WCMSAP Webinar Registration:

Name (first and last):
Email Address:
Company Name:
Tel. Number:
Receipt of invitation which reserves space in Outlook Calendar (i.e. an iCal) (Yes/No):

Sabtu, 30 Juli 2011

National Analysis of Workers Compensation Medical Benefits

The just published, Issue 3 of the Workers’ Compensation Resources Research Report (WCRRR) provides 23 years of information on cash benefits, medical benefits, and total (cash plus medical) benefits per 100,000 workers for up to 47 jurisdictions each year. Workers’ compensation benefits per 100,000 workers varied significantly nationally over these years.

In the most recent six years, total benefits per 100,000 workers increased by less than one percent in two years and declined in the other four years. There also typically are wide differences among jurisdictions in the generosity of benefits in a particular year. In 2007, for example, total benefits per 100,000 workers were more than fifty percent about the national average in five states and more than fifty percent below the national average in one jurisdiction. Over the 23 years, the differences among states have narrowed for cash benefits, medical benefits, and total benefits, although the differences among states in medical benefits have increased since 1998.

The WCRRR is edited by John F. Burton, Jr. Additional information about Issue 3 and an order form are available at www.workerscompresources.com.
Related articles

Selasa, 26 Juli 2011

7 Problems Facing Work Comp in a Credit Default

White House Photo, Pete Souza, 7/25/11

Workers' Compensation payments are so intertwined with the national system of workers' compensation that a potential US credit fault will impact the system significantly. Workers' Compensation is social remedial legislation and as the US government leaders struggle to find a political solution to the nation's financial crisis concern becomes focussed on how a shutdown will impact the national workers' compensation system.

The consequences of a US credit default will be significant. President Obama stated, "If that happens, and we default, we would not have enough money to pay all of our bills -– bills that include monthly Social Security checks, veterans’ benefits, and the government contracts we’ve signed with thousands of businesses. "

1. Centers for Medicare and Medicaid Services (CMS) and their contractor will be unable to provide conditional payment information under the Medicare Secondary Payer Act. Negotiations in workers compensation matters will come to halt.

2. CMS will be unable to approve compromises and releases in advance of workers' compensation disposition thereby halting the State systems.

3. CMS and their agents will be unable to review Medicare Set-Aside Agreements thereby stopping workers' compensation dispositions by compromise.

4. Chaos will erupt in those States where Social Security takes a reverse offset on permanency payments. Workers' compensation insurance companies and employers will become responsible for the entire amount to be paid.

5. The Veterans' Administration will be unable to provide information concerning medical treatment. Records will he held-up and will delay evaluations in adjudications in workers' compensation cases.

6. Tricare and other federal insurance providers will be unable to provide benefit information. The lack of reimbursement data will stymie evaluation of medica reimbursement issues slowing the disposition and settlements of workers' compensation claims.

7. The US Military will be unable to provide Personnel Records and prior medical treatment and claim information.

The potential fiscal impact of a US debt crisis is enormous. Hopefully, the politicians in Washington will reach a compromise and the this crisis will be resolved and everyone can creatively focus on making the compensation system less complicated and more efficient.

Senin, 25 Juli 2011

US Senate to Hold Hearing on Federal Comp System Reform

On Tuesday, U.S. Senator Daniel K. Akaka (D-HI) will hold a hearing titled Examining the Federal Workers' Compensation Program for Injured Employees to examine reform proposals for the Federal Employees Compensation Act (FECA).

The Federal Employees Compensation Act (FECA) provides workers' compensation coverage to federal civilian workers for any injury or illness incurred on the job. FECA has not been significantly updated in close to 40 years. A number of changes have been proposed, which are intended to modernize the program, improve return-to-work incentives, and reduce the overall cost to the Federal government. Discussion will focus largely on proposals to reduce FECA wage loss compensation benefits for disabled FECA recipients who reach retirement age.

EXAMINING THE FEDERAL WORKERS’ COMPENSATION PROGRAM FOR INJURED EMPLOYEES

Subcommittee on Oversight of Government Management, the Federal Workforce, and the District of Columbia

Live video will not be available until approximately 15 minutes prior to the scheduled hearing start time.

Tuesday, July 26, 2011
02:00 PM - 05:00 PM
Dirksen Senate Office Building, room SD-342

The hearing will be webcast live at: hsgac.senate.gov

Individuals with disabilities who require an auxiliary aid or service should contact Aaron Woolf, Subcommittee Chief Clerk, no later than 3 business days before the hearings. This will allow the office a reasonable amount of time before the event to make any necessary arrangements.

Add To My Calendar (vCal)

Witnesses

Panel 1

The Honorable Christine M. Griffin
Deputy Director
U.S. Office of Personnel Management
Mr. Gary Steinberg
Acting Director, Office of Workers’ Compensation Programs
U.S. Department of Labor
Mr. Andrew Sherrill
Director, Education, Workforce, and Income Security
U.S. Government Accountability Office

Panel 2

Mr. Joseph Beaudoin
President
National Active and Retired Federal Employees Association
Mr. Ronald Watson
Consultant
National Association of Letter Carriers, AFL-CIO
Dr. Gregory Krohm
Executive Director
International Association of Industrial Accident Boards and Commissions

Kamis, 21 Juli 2011

That Used to Be Comp

A parallel can be drawn between the concepts discussed by Thomas Friedman, at the National Governors Conference last week, and the status of the ailing workers’ compensation system in the US. The present problems, that have been the subject of Band-Aid statutory reform and regulatory directives, lack creative solutions. Reinventing America and workers compensation must incorporate the challenges of globalization, technology, national deficits and energy consummation, to meet the demands of the new world.

Mr. Friedman is the foreign affairs columnist for the New York Times, recipient of three Pulitzer Prizes, and is the author 5 best sellers. His newest book, “That Used To Be Us” is scheduled for release in September. He declares that “the American dream is in peril.” What worked in the past for the Nation to be a vibrant economy will no longer work in the future. Change is necessary.

The State workers’ compensation system, crafted over one hundred years ago, in the time of the American Industrial Revolution, no longer functions as an efficient, remedial and expeditious method for the handling of disability claims. Traumatic events have given way to multifaceted occupational diseases, the simplicity of single stage medical treatment protocols have multiplied into complex and costly: diagnostics, treatment modalities, and pharmaceutical regiments, that are accentuated with personalized genetic modeling.

The world of workers’ compensation will have difficulty meeting its responsibilities without adequate funding as payrolls fall, fewer people become employed as technology takes the place of jobs, and workload is distributed across the globe and into The Cloud. Creative thinking is necessary to look forward and determine how to administer and reconfigure the compensation system so that it meets the needs of injured workers rather than rejects them. A Labor force that is healthy will strengthen the national economy. Instead of dueling at every street corner in the land over medical fees and payment reimbursement, it is time to look at an inventive and universal remedy.

Thomas Friedman remarked that in the future there will be two types of nations, The High Imagining Enabled (HIE) countries and the Low Imagining Enabled (LIE) countries. The United States needs to relook at what used to be an efficient and functioning workers’ compensation system, and redevelop it through creative thinking and available global technology, to make it workable once again.

That Used To Be Us: How America Fell Behind in the World It Invented and How We Can Come Back, Thomas L. Friedman and Michael Mandelbaum, Farrar, Straus and Giroux (September 5, 2011), 400 pp.