Cases & Points Blog

CMS Issues New Self-Administration Tool Kit

CMS has issued a new Self-Administration Tool Kit for Workers’ Compensation Medicare Set-Aside Arrangements (WCMSA) version 1.3.  Changes from the prior version of the Tool Kit  include new information on the enhancement of the WCMSA Portal allowing the beneficiary,  his/her representative, or other identified administrator to electronically file yearly attestation statements.  In addition, Section 10 […]

Medicare Compliance Spooktacular

In this Halloween edition of our NuQuest blog we highlight some of the tricks and treats that have been passed down to us by CMS in 2019.  Tricks LMSAs/No-Fault MSAs Proposed Rulemaking for LMSA/No-Fault cases was originally set to be released in September 2019.  This was then pushed back to October 2019.  Although the month/year […]

Section 111 Penalties Closer Than We Think?

According to information located on the Office of Information and Regulatory Affairs (OIRA) website, the proposed rule for Civil Money Penalties and Medicare Payer Reporting Requirements is currently under review as an executive order submission.  This was received on September 19, 2019.  As noted in our prior blog, the proposed rule was pushed back to […]

Workers’ Compensation Medicare Set-Aside Electronic Attestation Enhancement

CMS will be hosting two webinars on the new Workers’ Compensation Medicare Set-Aside (WCMSA) Electronic Attestation Enhancements.  The first webinar will take place on October 30. 2019 and is directed to Medicare beneficiaries and their representatives.  The second webinar will be directed to Professional Administrators and will be held on November 6, 2019.  Additional details […]

More Scrutiny Being Placed on Administration Of MSA Funds

A class action suit that was recently filed in the Northern District Court of Alabama and was thereafter withdrawn voluntarily highlights post-settlement scrutiny of the administration of MSA funds.  In the Complaint filed on behalf of Joshua Sharp and similarly situated individuals, it was alleged that a post-settlement administration company, Ametros Financial Corp., advertised various […]

New Life Tables for WCMSAs

Beginning October 12, 2019, CMS will be utilizing the CDC’s “Table 1: Life Table for the total population: United States, 2016“ for the Workers’ Compensation Medicare Set Aside life expectancy calculations. A link to the CDC’s 2016 Life Tables may be found here  CDCs 2016 Life Tables

Brace for Changes to the MSA and Section 111 Process

The Medicare compliance industry continues to brace for changes to the MSA and Section 111 process based upon Notice of Proposed Rulemaking issued by CMS in 2018.  Many questions continue to loom regarding this process and particularly how the claimant and defendants will be protected if these rules are implemented. With various industry studies and […]

October 2019 Proposed Rulemaking Changes

As previously reported by NuQuest, read here, the Department of Health and Human Services/ Centers for Medicare and Medicaid Services  issued Notice of Proposed Rulemaking (NPRM)  in December 2018 involving Medicare Section 111 Monetary Penalties (Civil Monetary Penalties and Medicare Secondary Payer Reporting Requirements) and no-fault, liability and workers’ compensation Medicare obligations for future medicals […]

Beware of WCMSA Administrators in Sheep’s Clothing

In a recent decision issued by the Superior Court of Long Beach California, financial advisor, Tom Fallon, was convicted of 25 criminal counts of money laundering and grand theft related to the administration of Workers’ Compensation Medicare Set-Aside (WCMSA) accounts.  A year-long investigation by the California Insurance Department revealed that Mr. Fallon allegedly coerced claimants […]

a depiction of the cost of medicine

Generic Lyrica Prices Continue to Reduce

On July 19, 2019, the U.S. Food and Drug Administration approved multiple applications for generics of Lyrica (pregabalin).  Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research noted that “approval of the first generics for pregabalin…is another example of the FDA’s longstanding commitment to advance patient access to lower-cost, high-quality medicines.” […]