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February 11, 2021 Rasa Fumagalli, JD, MSCC, CMSP-F Securing CMS review of a Workers’ Compensation Medicare Set-Aside (WCMSA) proposal can, at times, be cumbersome.  Once the CMS WCMSA determination letter is received, parties may often just close their files after the settlement funds are disbursed. This brief article will address the frequently overlooked CMS determination finalization process. Parties that seek CMS review of a WCMSA should follow the guidelines that are set forth in CMS’ WCMSA Reference Guide (Guide). The most current version of the Guide, Version 3.2 was released on October 5, 2020, and outlines the process used by…
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February 11, 2021 Teresa Kenyon, Esq. The dreaded ERISA lien. The vendors representing ERISA self-funded health plans’ interests certainly want you to believe that it must be reimbursed in full. They will cite the US Airways v McCutchen case, tell you that they are not subject to equitable doctrines, and, therefore, do not have to reduce for attorney fees, limit, or waive their full recovery even if your client was not made whole from a compromised settlement. How do you get an ERISA plan to be fair and equitable? What is ERISA? ERISA is an acronym for the Employee Retirement…
February 3, 2021 Rasa Fumagalli, JD, MSCC, CMSP-F and Jennifer L. Yu, Esq. In stark contrast to the world of worker’s compensation, most attorneys agree that there is a dangerous amount of gray area surrounding the subject of Medicare Set-Asides for liability settlements.  This is so because the Centers for Medicare and Medicaid Services (CMS) has been slow in providing any real guidance for liability settlements that include compensation for future medicals costs. To date, the guidance consists of the May 2011 CMS Stalcup memo (one regional director’s view) and the September 2011 CMS memo regarding treating physician…
February 2, 2021 Synergy handles Hospital Lien disputes nationally on behalf of Trial Lawyers and their injured clients. Synergy’s Michael Walrath, Esq., as the nation’s leading authority on the nuances of state-specific hospital lien law and the facts underlying the “reasonable value” of hospital care, was tapped to assist investigative reporter Jessica Silver-Greenberg in her research for the New York Times expose of hospital lien practices. The article, entitled How Rich Hospitals Profit From Patients in Car Crashes, was published on February 1st, 2021, and can be viewed in its entirety here. As this explosive report details, hospitals routinely…
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January 14, 2021 Rasa Fumagalli, JD, MSCC, CMSP-F Personal injury settlements involving Medicare beneficiaries will often have conditional payment claims by Medicare and/or Part C plan liens. Since accurate and complete information regarding Medicare’s payments may be unavailable during settlement negotiations, practitioners may find themselves engaged in guesswork. The confusion between Medicare’s interim and final conditional payment figures have also resulted in post-settlement disputes between parties. Lack of information on Part C plan liens also can lead to exposure for double the lien amount.  This article will examine the Medicare Secondary Payer (MSP) Act conditional payment obligations/Part C plan liens…
January 12, 2021 The Medicare program—and the related Social Security Disability Income/Retirement benefit (SSDI)—is one of the primary benefit programs available to those who are injured and disabled. Understanding the basics of this program is imperative to protecting the client’s eligibility for their benefits. Medicare and SSDI benefits are an entitlement and are not income or asset sensitive. Clients who meet Social Security’s definition of disability and have paid enough quarters into the system can receive disability benefits regardless of their financial situation. For more information, read this excerpt from Synergy’s CEO, Jason D. Lazarus’ book ‘The Art of Settlement’.…
December 10, 2020 Rasa Fumagalli, JD, MSCC, CMSP-F The Centers for Medicare & Medicaid Services (CMS) recently issued a press release announcing a steady decline in improper payments under the Medicare Fee-For-Service program over the past few years. The improper payment rate decreased to 6.27% in the fiscal year 2020, down from 7.25% in the fiscal year 2019. CMS estimated that their corrective actions prevented approximately $15 billion dollars in improper payments. The corrective actions were based on the identification of root causes of improper payments.  According to the release, “improper payments represent payments that don’t meet program requirements– intentional…
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November 17, 2020 What do you do when you settle a case like this where your client is on public assistance, there are allocation issues, settlement planning issues must be addressed, and there are liens to negotiate? Where can you “park” the money while you set up any necessary public benefit preservation trusts, determine allocation of the proceeds, figure out a financial plan, and negotiate the liens? How can you get the money from the defendant immediately without ruining the client’s available settlement planning options? For more information, read this excerpt from Synergy’s CEO, Jason D. Lazarus’ book ‘The Art…
November 12, 2020 By: Rasa Fumagalli, JD, MSCC, CMSP-F The Centers for Medicare and Medicaid Services (CMS) has been slow in providing detailed guidance in the area of liability settlements that include compensation for future medicals. To date, the guidance consists of the May 2011 CMS Stalcup memo and the September 2011 CMS memo regarding treating physician certifications. Although CMS issued Notice of Proposed Rulemaking regarding Liability Medicare Set-Asides (LMSA) and settlement of future medicals in 2013, it was withdrawn in October of 2014. In the fall of 2018, the Department of Health and Human Services issued an…
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November 10, 2020 Mrs. Smith was moved to the ICU and no neurologic monitoring was performed that evening after being moved from the surgical suite. The next morning, Mrs. Smith was found to be quadriparetic. A suit was brought against multiple defendants with a significant seven-figure recovery secured. Mrs. Smith and her family had Medicaid coverage and SSI. She had also applied for Social Security Disability Income (SSDI). At the time of settlement, there was no Medicare eligibility, since she had not been approved for SSDI and she wasn’t sixty-five. In the confusing landscape of public benefits and planning issues…