Cases & Points Blog

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A class action suit that was recently filed in the Northern District Court of Alabama and was thereafter withdrawn voluntarily highlights post-settlement scrutiny of the administration of MSA funds.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.” […]

Pregabalin (Lyrica) now available on the Red Book Database

CMS’ inclusion of Lyrica in certain Workers’ Compensation Medicare Set-Asides has caused allocations to increase significantly.  The Red Book, which is the pricing source for prescription medications utilized by CMS, has included brand name Lyrica at a cost of over $9.00 per pill.    As of July 1, 2019, Red Book now includes pricing for a […]

Senate Bill 135 Exceptions to Georgia 400 Week Limit and the Impact on WCMSAs

Pursuant to O.C.G.A Sec. 34-9-200, payment of medical expenses in workers’ compensation claims with dates of injury on or after July 1, 2013, were capped at 400 weeks for claims that were no-catastrophic in nature. Senate Bill 135, which will become effective on July 1, 2019, now eliminates the 400-week cap for certain medical items […]

CMS Issues Medicare Advantage and Part D Pricing Final Rule (CMS-4180-F)

On May 16, 2019, CMS issued the Medicare Advantage and Part D Pricing Final Rule (CMS-4180-F) which is aimed at providing greater transparency in prescription drug costs and enabling Medicare Advantage (MA) plans to negotiate better pricing for physician-administered medicines. The significant provisions of the final rule include the following: The final rule codifies existing […]

Commercial Repayment Center (CRC) Outreach Program: Getting to know your CRC Operator

Commercial Repayment Center (CRC) Outreach Program: Getting to know your CRC Operator NuQuest recently met with the operator of CRC, Performant Financial Corporation, as a part of their stakeholder outreach program.  Performant Financial Corporation began operating CRC in February of 2018. More about this can be found here. At the meeting, CRC provided a presentation […]