Cases & Points Blog

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 […]

NuQuest Has A New Website!

Exciting news! We have launched the next generation of The website launch is part of an ongoing initiative to increase awareness of our large portfolio of service offerings. “As NuQuest offers much more than a traditional MSA product, we determined that it was time to better showcase our full portfolio,” said Tracey Lazzopina, CEO of NuQuest. […]

Now Available – CMS Electronic Payment Enhancement Overview

CMS has now posted the Electronic Payment Enhancement Overview Webinar presentations which were held on March 13, 2019, for NGHP and March 14, 2019, for GHP.  The presentations can be found in the Downloads section of the Coordination of Benefits & Recovery Overview What’s New page on