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Week of January 23 - January 27, 2017
Happy New Year!
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Welcome to your weekly WCI Newsletter. We have selected the top stories that appeared on our website this week to help you stay up to date on what is happening in the world of workers' compensation and insurance. Enjoy.
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CMS Recovery Practice Ruled Improper Under the MSP
By: Mark Popolizio
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 (MSP) and its supporting regulations.
This new decision-and its larger claims impact-are broken down as follows:
Read More.
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Medicare Advantage Organization Allowed to Sue Law Firm and Lawyer Over Conditional Payments
A Federal Court has ruled that a Medicare Advantage Organization (MAO) is permitted under the law to sue a law firm and a lawyer for the failure to reimburse conditional medical expenses arising out of an accident.
US District Court Judge, Henry E. Hudson, ruled that the Medicare Secondary Payer statute created a private cause of action to pursue recovery for conditional payments that it made on the beneficiary's behalf for medical expenses resulting from an automobile accident.
Read more.
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Health Wonk Review: The "Words Matter" Edition
Words matter. Right now, for good or bad, as the torch is being passed from one president to new one, one of the key platforms that PEOTUS ran on was eliminating Obamacare. But as the reality of that potential grows closer, social media is abuzz with debates. It would appear that some people didn't fully understand what they signed up for. Going viral on Facebook, a poster celebrates the demise of Obamacare, patting himself on the back that he had the good sense to go with the Affordable Care Act instead. This person is not alone - witness the Twitter poster who berates Senator Murray: "Why don't you shut up Murry. Stop Crying. You lost. We won. We are repealing Obamacare, not the ACA." We could post more examples, but you get the point. Polls have repeatedly demonstrated that words matter - the healthcare law is viewed much more favorably as the ACA than as Obamacare. And a number of insureds don't realize they are one and the same. We may soon have the dubious privilege of learning how widespread this confusion is.
Read More
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MSA Optimism for the New Year Intelligence System
By: Lavonya Chapman
The Centers for Medicare & Medicaid Services (CMS) announced the organization will be reconsidering a new policy in 2017 regarding re-reviews of otherwise approved Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) amounts. According to the CMS announcement, this new policy would only apply to claims "where settlement has not occurred." As such, if settlement has been agreed upon CMS will not consider a re-review. The timing of any such change, however is yet unknown.
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Think About it: Addressing Mental Health in the Workplace
By: Bryon Bass, SVP, Disability and Absence Practice & Compliance, Sedgwick
On December 8, I hosted a webinar along with Donna Hardaker, former Director, Wellness Works Mental Health America of California and Heather Holladay, Integrated Health Manager Pacific Gas and Electric Company. It was a fantastic discussion on a topic which needs much more attention: stigma and social prejudice toward employees with mental health challenges. If you were not able to attend, you can revisit the recorded webinar and our presentation slides.
Read More
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