Errors and Omissions Liability Insurance for Medicare Statutory Compliance

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Errors and Omissions Liability Insurance for Medicare Statutory Compliance"

Transcription

1 The Problem and the Solution Medicare/Medicaid and SCHIP Extension Act of 2007 Errors and Omissions Liability Insurance for Medicare Statutory Compliance INSURANCE GROUP

2 In 1980, in an effort to help curb the rising cost of Medicare, Congress enacted the Medicare Secondary Payer statute to establish the principle that Medicare is always a secondary payer, or payer of last resort, when other sources of funding exist. All payments advanced by Medicare are in fact only conditional payments: Medicare is entitled to reimbursement when alternative sources are identified. Potentially ruinous to business! The Medicare, Medicaid and SCHIP Extension Act, signed into law in 2007, has wide-ranging and potentially ruinous consequences to all entities who choose to selfinsure their workers compensation or third-party liability exposures. These employers may soon be confronted with demands from Medicare for reimbursement for claims they thought were settled.

3 Beginning on January 1, 2010, Section 111 ( Medicare Secondary Payer ) of the 2007 Extension Act requires liability and workers compensation insurers (including self-insurers) to determine Medicare status for all claimants and to report all claims involving a Medicare beneficiary to the Centers for Medicare and Medicaid Services ( CMS ) when those claims are paid. How Bad is the Problem? The Extension Act gives the CMS a direct right of action against primary payers (insurers and self-insurers) and others responsible for paying liability and workers compensation claims and recipients of loss and medical payments from a primary payer. If Medicare is not reimbursed for its medical costs, CMS can sue the primary payers for reimbursement, even if the claims payments were made by a third party administrator, and regardless of whether the claims settlement was approved by a state court.

4 The Federal Government is entitled to double damages in the event it institutes legal action to effect reimbursement. Self insurers also face federal fines of up to $1,000 per day for each claim they fail to properly report in a timely manner. Who s at risk? Any business, corporation, partnership, public entity, governmental agency, pool, trust, state claims fund, etc. that self insures its liability with respect to injured individuals and/or its statutory liability to provide workers compensation or no-fault benefits to injured workers and other individuals. Included are state agencies which provide benefits directly to injured parties.

5 The application of the law is not limited to domestically domiciled self-insured entities. Multinational organizations, foreign nations, American Indian and Alaska Native Tribes are also subject to Medicare Secondary Payer provisions. Bankrupt organizations and entities in liquidation are at risk, as well. The Medicare Secondary Payer provision also applies to fronting policies obtained by self-insurers, since the intent of such arrangements is that the insured, rather than the fronting insurer, will pay all claims. When the insured pays the claims, the insured is considered the Responsible Reporting Entity (RRE). What s the Solution? Medicare Statutory Compliance Errors and Omission Liability Insurance from American Empire Surplus Lines Insurance Company is specifically tailored to address the new and emerging exposures created by the passage of the Medicare, Medicaid and SCHIP Extension Act of 2007 and Section 111. Medicare Statutory Compliance Errors and Omissions is targeted at a wide range of self insured entities. Our insuring agreement specifically targets violations of 42 U.S.C. 1395y(b)(2) or (8), or an equivalent state statute. Coverage is provided on a claims made basis. Various deductible levels can be offered. Limits up to $5,000,000 are available.

6 INSURANCE GROUP For more information, professional risk managers, agents and brokers may American Empire at To download a policy application for Errors & Omissions Liability Insurance for Medicare Statutory Compliance, visit Whenever laws are enacted or changed, it generally is beneficial for insurance agents and brokers to seek the advice of counsel to further their understanding of the responsibilities and resultant liabilities that are now imposed on their clients. The Medicare Statute enacted in 1980 and the SCHIP Extension Act of 2007 are complicated, as are the associated state statutes addressing Medicaid. We think it prudent for you to discuss these laws with legal counsel to fully understand their import. Underwritten by American Empire Surplus Lines Insurance Company, a Delaware corporation licensed in Delaware and an eligible surplus lines insurer in the other 49 states and the District of Columbia. INSURANCE GROUP Coverage benefits are summarized. Refer to the policy declarations and contract for a full description of applicable terms, conditions, exclusions and limitations. Coverage may not be available in all jurisdictions. This advertisement is intended for use by licensed insurance producers. It is not intended as a solicitation or offer to sell any insurance product in any jurisdiction in which such solicitation or offer, or the sale or purchase of the described insurance product would be unlawful under the insurance laws and regulations of such jurisdiction. American Empire Surplus Lines Insurance Company is a member of Great American Insurance Group, 580 Walnut Street, Cincinnati, OH GAIC 2770 (10/09)

New Medicare Reporting Requirements for Entities Paying Settlements or Judgments To Personal Injury Plaintiffs Who Are Medicare Beneficiaries

New Medicare Reporting Requirements for Entities Paying Settlements or Judgments To Personal Injury Plaintiffs Who Are Medicare Beneficiaries New Medicare Reporting Requirements for Entities Paying Settlements or Judgments To Personal Injury Plaintiffs Who Are Medicare Beneficiaries By Pamela W. Montgomery, R.N., J.D., LL.M. candidate (Health

More information

Mandatory Reporting Thresholds Friday, October 09, 2015

Mandatory Reporting Thresholds Friday, October 09, 2015 Slide 1 - of 26 Welcome to the Mandatory Reporting Thresholds course. Note: This module applies to Responsible Reporting Entities (RREs) that will be submitting Section 111 claim information via an electronic

More information

Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation

Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE Chapter III: POLICY GUIDANCE Rev.

More information

New M&A insurance risk for buyers Medicare-related settlement clawback

New M&A insurance risk for buyers Medicare-related settlement clawback January 2011 A publication from the Transaction Services practice New M&A insurance risk for buyers Medicare-related settlement clawback At a glance Companies across a wide range of industries must consider

More information

Medicare Indemnity and Defense by Federal Mandate?

Medicare Indemnity and Defense by Federal Mandate? Medicare Indemnity and Defense by Federal Mandate? Christian R. Johnson Ebanks Horne Rota Moos LLP 1301 McKinney, Suite 2700 Houston, TX 77010 (713) 333-4500 (713) 333-4600 [fax] cjohnson@ethlaw.com www.ethlaw.com

More information

MEDICARE AND LIABILITY CASES. A. The Medicare Secondary Payer Statute

MEDICARE AND LIABILITY CASES. A. The Medicare Secondary Payer Statute MEDICARE AND LIABILITY CASES I. The Significant Statutory and Code Provisions A. The Medicare Secondary Payer Statute The Medicare Secondary Payer statute (MSP) has been the law for well over 25 years.

More information

CLM 2016 Atlanta Conference May 19-20, 2016 in Atlanta, GA

CLM 2016 Atlanta Conference May 19-20, 2016 in Atlanta, GA CLM 2016 Atlanta Conference May 19-20, 2016 in Atlanta, GA Medicare Secondary Payer Compliance: The Critical Transition to the Commercial Repayment Center (CRC) What is Medicare? Medicare is an entitlement

More information

The Reporting Requirement You May Not Know About that Could Cost Your

The Reporting Requirement You May Not Know About that Could Cost Your The Reporting Requirement You May Not Know About that Could Cost Your Company $1,000 per Day The Mechanics and Litigation Repercussions of MMSEA 111 Jennifer A. Creedon jcreedon@verrilldana.com (617) 309-2618

More information

Best Practices for Complying with New Medicare Reporting Requirements What Every Attorney Needs to Know By Ervin A. Gonzalez, Esq.

Best Practices for Complying with New Medicare Reporting Requirements What Every Attorney Needs to Know By Ervin A. Gonzalez, Esq. Best Practices for Complying with New Medicare Reporting Requirements What Every Attorney Needs to Know By Ervin A. Gonzalez, Esq. I. Overview: How does the MMSEA impact personal injury and mass tort settlements?

More information

Subrogation and Liens: Basic Principles and Practical Considerations. Brandon E. Berg Thompson, Coe, Cousins & Irons, L.L.P.

Subrogation and Liens: Basic Principles and Practical Considerations. Brandon E. Berg Thompson, Coe, Cousins & Irons, L.L.P. Subrogation and Liens: Basic Principles and Practical Considerations Brandon E. Berg Thompson, Coe, Cousins & Irons, L.L.P. Houston, Texas Texas Hospital Lien Statute Texas Property Code gives a hospital

More information

Welcome to the Reportable Claims course.

Welcome to the Reportable Claims course. Welcome to the Reportable Claims course. Note: This module applies to Responsible Reporting Entities (RREs) that will be submitting Section 111 claim information via an electronic file submission as well

More information

Understanding the Medicare, Medicaid and SCHIP Extension Act of 2007

Understanding the Medicare, Medicaid and SCHIP Extension Act of 2007 Understanding the Medicare, Medicaid and SCHIP Extension Act of 2007 CNA believes we are more than your underwriting and risk management provider. Our ongoing customer service, technical support, and consultative

More information

made by private organizations (called primary payers or primary plans). 4 This includes liability

made by private organizations (called primary payers or primary plans). 4 This includes liability passage of the Medicare Secondary Payer Act ( MSP ) 2 in 1980 provided for a redistribution of the primary payment burden. 3 Today, Medicare is a secondary payer to other available payment sources for

More information

SPECIAL NEEDS TRUST NEWSLETTER

SPECIAL NEEDS TRUST NEWSLETTER SPECIAL NEEDS TRUST NEWSLETTER SEPTEMBER 2009 A. KEL LONG, III P.C. 3060 Peachtree Rd., Suite 1725 Atlanta, GA 30305 404 238 0174 AKL3PC@mindspring.com www.akellong.com For this edition of the newsletter,

More information

LIEN ON ME. A Guide to Complying with Medicare s Secondary Payor Act and Pennsylvania s Act 44. April, 2009

LIEN ON ME. A Guide to Complying with Medicare s Secondary Payor Act and Pennsylvania s Act 44. April, 2009 LIEN ON ME A Guide to Complying with Medicare s Secondary Payor Act and Pennsylvania s Act 44 April, 2009 HARRISBURG OFFICE P.O. Box 932 Harrisburg, PA 17106-0932 717-975-8114 PITTSBURGH OFFICE 525 William

More information

Welcome to the Medicare Secondary Payer (MSP) Overview course.

Welcome to the Medicare Secondary Payer (MSP) Overview course. Welcome to the Medicare Secondary Payer (MSP) Overview course. 1 While all information in this document is believed to be correct at the time of writing, this Computer Based Training (CBT) is for educational

More information

Glossary of Terms and Acronyms

Glossary of Terms and Acronyms Glossary of Terms and Acronyms COB/COBC Coordination of Benefits - The Coordination of Benefits Contractor consolidates the activities that support the collection, management, and reporting of other insurance

More information

Hospital Liens, Medicare and Medicaid: Trouble Ahead?

Hospital Liens, Medicare and Medicaid: Trouble Ahead? A MEDICAL-LEGAL NEWSLETTER FOR PERSONAL INJURY ATTORNEYS BY DR. STEVEN W.SHAW Hospital Liens, Medicare and Medicaid: Trouble Ahead? Several years ago I was informed by an attorney that Danbury Hospital

More information

ISSUES ARISING OUT OF THE MEDICARE SECONDARY PAYER ACT

ISSUES ARISING OUT OF THE MEDICARE SECONDARY PAYER ACT ISSUES ARISING OUT OF THE MEDICARE SECONDARY PAYER ACT BY EUGENE J. PODESTA, JR. BAKER, DONELSON, BEARMAN, CALDWELL & BERKOWITZ 165 Madison Avenue, Suite 2000 Memphis, TN 38103 Rising medical costs and

More information

WHAT YOU NEED TO KNOW ABOUT MEDICARE LIENS, CONDITIONAL PAYMENTS, AND SET ASIDE TRUSTS

WHAT YOU NEED TO KNOW ABOUT MEDICARE LIENS, CONDITIONAL PAYMENTS, AND SET ASIDE TRUSTS WHAT YOU NEED TO KNOW ABOUT MEDICARE LIENS, CONDITIONAL PAYMENTS, AND SET ASIDE TRUSTS Presented and Prepared by: Bradford J. Peterson bpeterson@heylroyster.com Urbana, Illinois 217.344.0060 The cases

More information

HOOPS 2008. MSP Update: New Programs, Added Burdens, Possible Expanded Opportunities Focus on CMS Implementation of Mandatory Insurance Reporting

HOOPS 2008. MSP Update: New Programs, Added Burdens, Possible Expanded Opportunities Focus on CMS Implementation of Mandatory Insurance Reporting HOOPS 2008 MSP Update: New Programs, Added Burdens, Possible Expanded Opportunities Focus on CMS Implementation of Mandatory Insurance Reporting Robert L. Roth Crowell & Moring, LLP 1001 Pennsylvania Avenue,

More information

USING MEDICARE SET-ASIDE ARRANGEMENTS IN THIRD PARTY LIABILITY CASES By: Thomas D. Begley, Jr.

USING MEDICARE SET-ASIDE ARRANGEMENTS IN THIRD PARTY LIABILITY CASES By: Thomas D. Begley, Jr. USING MEDICARE SET-ASIDE ARRANGEMENTS IN THIRD PARTY LIABILITY CASES By: Thomas D. Begley, Jr. This Special Report is brought to you by Begley Law Group. begleylawgroup.com This newsletter is not intended

More information

Workers Compensation & Medicare Set-Asides"

Workers Compensation & Medicare Set-Asides Workers Compensation & Medicare Set-Asides" Presented by: Betty Gregware, CSSC Mutual of Omaha & Toni Warbington, CSSC EPS Settlements Group W/C vs. Tortfeasor Liability" No provision to bring suit against

More information

Quick Reference Guide Version 1 January 19, 2012

Quick Reference Guide Version 1 January 19, 2012 Centers for Medicare & Medicaid Services (CMS) MMSEA Section 111 Mandatory Insurer Reporting Quick Reference Guide Version 1 January 19, 2012 For Non-Group Health Plan (NGHP) Insurers The What, Why and

More information

1, 2011, and will apply to payment obligations assumed on or after October 1, 2010. See

1, 2011, and will apply to payment obligations assumed on or after October 1, 2010. See Medicare Reporting and Reimbursement Compliance Issues in Mass Products Liability Cases in which Exposure on or after December 5, 1980, is Generally Alleged, Established, and/or Released. By: Lynn O. Frye,

More information

SPECIAL TOPICS IN GUARDIANSHIP COMPROMISING CLAIMS FOR MINORS AND INCAPACITATED ADULTS. November 8, 2013

SPECIAL TOPICS IN GUARDIANSHIP COMPROMISING CLAIMS FOR MINORS AND INCAPACITATED ADULTS. November 8, 2013 SPECIAL TOPICS IN GUARDIANSHIP COMPROMISING CLAIMS FOR MINORS AND INCAPACITATED ADULTS November 8, 2013 Stephanie F. Brown McMickle, Kurey & Branch 200 South Main Street Alpharetta, GA 30009 (678) 824-7800

More information

Some individuals are dual eligible meaning they qualify for both Medicaid and Medicare. In

Some individuals are dual eligible meaning they qualify for both Medicaid and Medicare. In Understanding Dual Eligibility The Interplay between Medicare and Medicaid Jason D. Lazarus, Esq. Introduction Some individuals are dual eligible meaning they qualify for both Medicaid and Medicare. In

More information

www.cms.hhs.gov/mandatoryinsrep/01_overview.asp INTRODUCTION October 1, 2010.

www.cms.hhs.gov/mandatoryinsrep/01_overview.asp INTRODUCTION October 1, 2010. 1. INTRODUCTION Recent changes in federal law represent a sea change in the consideration that must be given by defendants to the interests of Medicare. Up until March, 2009, Medicare, when attempting

More information

Michigan Property & Casualty Guaranty Association P.O. Box 531266 Livonia, Michigan 48153-1266 Phone: (248) 482-0381

Michigan Property & Casualty Guaranty Association P.O. Box 531266 Livonia, Michigan 48153-1266 Phone: (248) 482-0381 Michigan Property & Casualty Guaranty Association P.O. Box 531266 Livonia, Michigan 48153-1266 Phone: (248) 482-0381 Dear Claimant: The Michigan Property & Casualty Guaranty Association ("the MPCGA") is

More information

Maryland Workers Compensation Commission Introduction

Maryland Workers Compensation Commission Introduction Maryland Workers Compensation Commission Introduction Medicare Secondary Payer Act & Workers Compensation Settlement Process What this is not... This presentation is not a tutorial on how to create and

More information

INSTRUCTION LETTER TRONOX TORT CLAIMS TRUST INSTRUCTION LETTER (CATEGORY A) Dear Prospective Claimant or Claimant Counsel,

INSTRUCTION LETTER TRONOX TORT CLAIMS TRUST INSTRUCTION LETTER (CATEGORY A) Dear Prospective Claimant or Claimant Counsel, INSTRUCTION LETTER Dear Prospective Claimant or Claimant Counsel, The Tronox Incorporated Tort Claims Trust (the Trust ) has been established under Chapter 11 of the Bankruptcy Code to resolve all Tort

More information

Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment

Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment Effective Date: September 1, 2013 Effective Date for Section 32 Agreements: October 1, 2013 Revised: December

More information

MEDICARE AND WORKERS= COMPENSATION CLAIMS WHO=S ON FIRST? Michael E. Rusin. January, 2002

MEDICARE AND WORKERS= COMPENSATION CLAIMS WHO=S ON FIRST? Michael E. Rusin. January, 2002 MEDICARE AND WORKERS= COMPENSATION CLAIMS WHO=S ON FIRST? Michael E. Rusin January, 2002 Michael E. Rusin Rusin Maciorowski & Friedman, Ltd. 10 South Riverside Plaza, Suite 1530 Chicago, IL 60606 (312)

More information

In 2007, Congress passed Section 111 to the Medicare, Medicaid

In 2007, Congress passed Section 111 to the Medicare, Medicaid SCHOLARLY ARTICLE What Every Attorney Must Know About Medicare Reporting and Reimbursement By Toni J. Ellington In 2007, Congress passed Section 111 to the Medicare, Medicaid and SCHIP Extension Act (MMSEA).

More information

MANDATORY INSURER REPORTING: A PRIMER FOR RESPONSIBLE REPORTING ENTITIES

MANDATORY INSURER REPORTING: A PRIMER FOR RESPONSIBLE REPORTING ENTITIES MANDATORY INSURER REPORTING: A PRIMER FOR RESPONSIBLE REPORTING ENTITIES INTRODUCTION Liability insurers, self-insured entities, and third party administrators should be aware of how Medicare s right to

More information

FEDERAL LIABILITY RISK RETENTION ACT OF 1986. 15 USC 3901-3906 (1981, as amended 1986)

FEDERAL LIABILITY RISK RETENTION ACT OF 1986. 15 USC 3901-3906 (1981, as amended 1986) FEDERAL LIABILITY RISK RETENTION ACT OF 1986 15 USC 3901-3906 (1981, as amended 1986) Sec. 3901 DEFINITIONS [Section 2]* Sec. 3902 RISK RETENTION GROUPS [Section 3] (a) EXEMPTION FROM STATE LAWS, REGULATIONS

More information

Lien Law: Recognizing and Management in the Personal Injury Case

Lien Law: Recognizing and Management in the Personal Injury Case Lien Law: Recognizing and Management in the Personal Injury Case I. INTRODUCTION At first blush, a personal injury plaintiff's procurement of proceeds either through settlement or adjudication may seem

More information

Medicare, Medicaid, and SCHIP Extension Act: What All Lawyers and Their Clients Must Know About the Act Before Settling a Personal Injury Claim

Medicare, Medicaid, and SCHIP Extension Act: What All Lawyers and Their Clients Must Know About the Act Before Settling a Personal Injury Claim Medicare, Medicaid, and SCHIP Extension Act: What All Lawyers and Their Clients Must Know About the Act Before Settling a Personal Injury Claim SPEAKERS: W. Randall Bassett Stephanie Ann Webster Tara Kay

More information

Workers Compensation Update Special Edition: Medicare Secondary Payer

Workers Compensation Update Special Edition: Medicare Secondary Payer By Roy Franco, Mark Noonan, and Stephanie Sorensen Medicare Secondary Payer Update The Medicare Secondary Payer Act (MSPA) 1 is a game-changer for claims offices across the country. The additional reporting

More information

Fixed Percentage Option

Fixed Percentage Option Fixed Percentage Option What Is the Fixed Percentage Option? In an effort to streamline the recovery process, the Centers for Medicare & Medicaid Services (CMS), directed the Benefits Coordination & Recovery

More information

Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment

Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment Effective Date: September 1, 2013 I. Authority A. The James Zadroga 9/11 Health and Compensation Act of 2010

More information

Report to Congress. Computation of Annual Liability Insurance (Including Self-Insurance) Settlement Recovery Threshold

Report to Congress. Computation of Annual Liability Insurance (Including Self-Insurance) Settlement Recovery Threshold Report to Congress Computation of Annual Liability Insurance (Including Self-Insurance) Settlement Recovery Threshold As Required by Section 202 of the Medicare IVIG Access and Strengthening Medicare and

More information

NEW MEXICO SELF-INSURERS' FUND WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY PLAN

NEW MEXICO SELF-INSURERS' FUND WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY PLAN NEW MEXICO SELF-INSURERS' FUND WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY PLAN In return for the payment of the premium and subject to all terms of this Policy, we agree with you as follows. GENERAL

More information

The Medicare Tsunami. Bigger than Medicare Set Asides. Stronger than the Medicare Secondary Payer Act. Faster than the end of the recession

The Medicare Tsunami. Bigger than Medicare Set Asides. Stronger than the Medicare Secondary Payer Act. Faster than the end of the recession The Medicare Tsunami Bigger than Medicare Set Asides Stronger than the Medicare Secondary Payer Act Faster than the end of the recession A Tsunami you can plan for 1 2 Outline Medicare Eligibility MSA

More information

Medicare, Workers Compensation, and Liability Insurance

Medicare, Workers Compensation, and Liability Insurance CAS Study Note Medicare, Workers Compensation, and Liability Insurance By George M. Levine, FCAS, MAAA Patty Smolen, FCAS, MAAA Jim Klann, FCAS, MAAA October 2012 Medicare, Workers Compensation, and Liability

More information

settlement planning guide for plaintiffs

settlement planning guide for plaintiffs settlement planning guide for plaintiffs If you expect to receive a settlement as the result of a major injury or the death of a loved one, it is normal to feel overwhelmed. You may have questions about

More information

Impediments to Settlement

Impediments to Settlement Impediments to Settlement W. Bruce Barrickman, Esq. 5775 Glenridge Drive Suite E100 Atlanta, GA 30328 678-222-0248 www.bayadr.com IMPEDIMENTS TO SETTLEMENT W. Bruce Barrickman, Esq. Mediation is a great

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services News Flash Medicare is denying an increasing number of claims, because providers are not identifying, nor sending claims

More information

Subpart B Insurance Coverage That Limits Medicare Payment: General Provisions

Subpart B Insurance Coverage That Limits Medicare Payment: General Provisions Subpart B Insurance Coverage That Limits Medicare Payment: General Provisions 411.20 Basis and scope. (a) Statutory basis. (1) Section 1862(b)(2)(A)(i) of the Act precludes Medicare payment for services

More information

Medicare Issues in Workers Compensation Settlements PRESENTED BY: MICHELLE A. ALLAN, ESQ.

Medicare Issues in Workers Compensation Settlements PRESENTED BY: MICHELLE A. ALLAN, ESQ. Medicare Issues in Workers Compensation Settlements PRESENTED BY: MICHELLE A. ALLAN, ESQ. Medicare Basics Medicare is a health insurance program provided by the federal government for: People 65 years

More information

Personal Injuries Happen. Justice Is Sought. Special Needs Must Be Addressed. Special Needs Require Special Settlement Planning

Personal Injuries Happen. Justice Is Sought. Special Needs Must Be Addressed. Special Needs Require Special Settlement Planning Personal Injuries Happen. Justice Is Sought. Special Needs Must Be Addressed. Special Needs Require Special Settlement Planning Why Use the Special Needs Law Firm? In most personal injury cases, the path

More information

GENERAL ASSEMBLY OF NORTH CAROLINA 1987 SESSION CHAPTER 310 SENATE BILL 310

GENERAL ASSEMBLY OF NORTH CAROLINA 1987 SESSION CHAPTER 310 SENATE BILL 310 GENERAL ASSEMBLY OF NORTH CAROLINA 1987 SESSION CHAPTER 310 SENATE BILL 310 AN ACT TO AMEND THE PRODUCT LIABILITY RISK RETENTION GROUP LAW BY REFLECTING THE FEDERAL RISK RETENTION AMENDMENTS OF 1986 IN

More information

Set-Aside Arrangements A Combined Effort by Robert W. Brown II, Esq. Moore Ingram Johnson & Steele, LLP

Set-Aside Arrangements A Combined Effort by Robert W. Brown II, Esq. Moore Ingram Johnson & Steele, LLP Set-Aside Arrangements A Combined Effort by Overview: When is Medicare an issue? What is required when Medicare is an issue? Dealing with CMS and Medicare. Problems associated with Medicare in the context

More information

8/17/2012. Workers Compensation Institute. Learning Objectives. Agenda. 2012 Educational Conference

8/17/2012. Workers Compensation Institute. Learning Objectives. Agenda. 2012 Educational Conference Workers Compensation Institute 2012 Educational Conference Seeing the Forest through the Trees: MSA/LMSA Trends Celia Mendez, Esq. Cynthia Sage, Esq. Rafael Gonzalez Moreland & Mendez FCCI Insurance Gould

More information

Workers' Compensation

Workers' Compensation Workers' Compensation Workers compensation provides benefits to injured employees for accidents or occupational diseases arising out of, and in the course of, their employment. Compensation coverage is

More information

Errors and Omissions Insurance. 1.0 Introduction and Definition

Errors and Omissions Insurance. 1.0 Introduction and Definition Errors and Omissions Insurance 1.0 Introduction and Definition 1.1 Under the terms of this policy the word employee means any trustee of the Board of Education, any employee of the Hicksville Board of

More information

SUBROGATION AND MSAs. Settlement of W/C Claim As Part of Third Party Settlement Commutation/Dollar Contracts, Etc.

SUBROGATION AND MSAs. Settlement of W/C Claim As Part of Third Party Settlement Commutation/Dollar Contracts, Etc. MEDICARE SET-ASIDES AND THE SUBROGATION PROFESSIONAL Presented By: Gary L. Wickert, Matthiesen, Wickert & Lehrer, S.C. Russell S. Whittle, Gould & Lamb, LLC GOTOWEBINAR ATTENDEE INTERFACE 1. Viewer Window

More information

SAFETY NET SHORT FORM INTERNET LIABILITY INSURANCE APPLICATION

SAFETY NET SHORT FORM INTERNET LIABILITY INSURANCE APPLICATION Chubb Group of Insurance Companies 15 Mountain View Road, Warren, New Jersey 07059 Executive Risk Indemnity Inc. 2711 Centerville Road Suite 400, Wilmington, Delaware 19808 SAFETY NET SHORT FORM INTERNET

More information

NEBRASKA PROPERTY AND LIABILITY INSURANCE GUARANTY ASSOCIATION ACT

NEBRASKA PROPERTY AND LIABILITY INSURANCE GUARANTY ASSOCIATION ACT NEBRASKA PROPERTY AND LIABILITY INSURANCE GUARANTY ASSOCIATION ACT Section. 44-2401. Purpose of sections. 44-2402. Kinds of insurance covered. 44-2403. Terms, defined. 44-2404. Nebraska Property and Liability

More information

STATE OF MICHIGAN IN THE CIRCUIT COURT FOR THE COUNTY OF WAYNE CASE MANAGEMENT ORDER #17

STATE OF MICHIGAN IN THE CIRCUIT COURT FOR THE COUNTY OF WAYNE CASE MANAGEMENT ORDER #17 Plaintiff understands that the Medicare Secondary Payer Act (42 U.S.C. 1395y(b))("Act") applies to any personal injury settlement involving a Medicare beneficiary and requires that Medicare be reimbursed

More information

PUBLIC ENTITY RISK MANAGEMENT AUTHORITY MEMORANDUM OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY COVERAGE

PUBLIC ENTITY RISK MANAGEMENT AUTHORITY MEMORANDUM OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY COVERAGE PUBLIC ENTITY RISK MANAGEMENT AUTHORITY MEMORANDUM OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY COVERAGE FOR THE PERIOD JULY 1, 2015 TO JUNE 30, 2016 EFFECTIVE: JULY 1, 2015 PUBLIC ENTITY RISK MANAGEMENT

More information

APPLICABLE PLAN APPEALS

APPLICABLE PLAN APPEALS APPLICABLE PLAN APPEALS Appealing a Medicare Secondary Payer Recovery Claim where Medicare pursues recovery from insurers or workers compensation entities. Presented by: The Division of Medicare Secondary

More information

Best Practices for Medicare Secondary Payer Compliance Industry Perspectives

Best Practices for Medicare Secondary Payer Compliance Industry Perspectives Best Practices for Medicare Secondary Payer Compliance Industry Perspectives Presenters: Tara Acton, CenturyLink Cliff Connor, Gallagher Bassett Services, Inc. Roy Franco, Franco Signor, LLC Brad Spicer,

More information

Title 24-A: MAINE INSURANCE CODE

Title 24-A: MAINE INSURANCE CODE Title 24-A: MAINE INSURANCE CODE Chapter 72-A: MAINE LIABILITY RISK RETENTION ACT HEADING: PL 1987, c. 769, Pt. A, 100 (rpr) Table of Contents Section 6091. SHORT TITLE... 3 Section 6092. PURPOSE... 3

More information

Medicare Secondary Payer In Action Recent Developments and Practical Tips. Eli Poliakoff, Esq. Gregory M. Fliszar, Esq.

Medicare Secondary Payer In Action Recent Developments and Practical Tips. Eli Poliakoff, Esq. Gregory M. Fliszar, Esq. Medicare Secondary Payer In Action Recent Developments and Practical Tips Eli Poliakoff, Esq. Gregory M. Fliszar, Esq. I. Relevant Authorities and Resources The MSP program is a wide-ranging collection

More information

Case 3:07-cv-01180-TEM Document 56 Filed 04/27/2009 Page 1 of 12 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA JACKSONVILLE DIVISION

Case 3:07-cv-01180-TEM Document 56 Filed 04/27/2009 Page 1 of 12 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA JACKSONVILLE DIVISION Case 3:07-cv-01180-TEM Document 56 Filed 04/27/2009 Page 1 of 12 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA JACKSONVILLE DIVISION JAMES E. TOMLINSON and DARLENE TOMLINSON, his wife, v. Plaintiffs,

More information

THE MEDICARE SECONDARY PAYER ACT A DIAMOND IN THE ROUGH! medical malpractice cases is resolving outstanding Medicare liens. Attorneys often complain

THE MEDICARE SECONDARY PAYER ACT A DIAMOND IN THE ROUGH! medical malpractice cases is resolving outstanding Medicare liens. Attorneys often complain THE MEDICARE SECONDARY PAYER ACT A DIAMOND IN THE ROUGH! Richard Neuworth is a partner at Lebau & Neuworth, L.L.C. located in Baltimore, Maryland. He also serves on the Maryland Association For Justice

More information

Welcome to the International Classification of Diseases, Ninth Revision (ICD-9) Diagnosis Code Requirements Part I course.

Welcome to the International Classification of Diseases, Ninth Revision (ICD-9) Diagnosis Code Requirements Part I course. Welcome to the International Classification of Diseases, Ninth Revision (ICD-9) Diagnosis Code Requirements Part I course. Note: This module applies to Responsible Reporting Entities (RREs) that will be

More information

The MSP Act s hidden remedy

The MSP Act s hidden remedy Goldberg_v07a ToAuthor The MSP Act s hidden remedy Dealing with Medicare reimbursement may be difficult, but the Medicare Secondary Payer Act provides a little-understood private cause of action that may

More information

Policy and Procedures for Recoupment: Lump-Sum Workers Compensation Settlements

Policy and Procedures for Recoupment: Lump-Sum Workers Compensation Settlements Policy and Procedures for Recoupment: Lump-Sum Workers Compensation Settlements Effective Date: October 1, 2013 Revised: January 4, 2015 I. Authority A. The James Zadroga 9/11 Health and Compensation Act

More information

MMSEA Section 111 MSP Mandatory Reporting

MMSEA Section 111 MSP Mandatory Reporting MMSEA Section 111 MSP Mandatory Reporting Interim Record Layout Information for: Liability Insurance (Including Self-Insurance) No-Fault Insurance Workers Compensation The complete Section 111 User Guide

More information

TRUST CLAIM FORM FOR TRONOX TORT CLAIMS TRUST TRUST CLAIM FORM (CATEGORY D)

TRUST CLAIM FORM FOR TRONOX TORT CLAIMS TRUST TRUST CLAIM FORM (CATEGORY D) TRUST CLAIM FORM This claim form sets forth your claim for recovery under the Tronox Incorporated Tort Claims Trust Distribution Procedures ( TDPs ). Please carefully follow all of the instructions in

More information

Covered Entity Charts

Covered Entity Charts Covered Entity Charts Guidance on how to determine whether an organization or individual is a covered entity under the Administrative Simplification provisions of HIPAA 2 Background: The Administrative

More information

CHAPTER 2016-194. Committee Substitute for Committee Substitute for Senate Bill No. 1170

CHAPTER 2016-194. Committee Substitute for Committee Substitute for Senate Bill No. 1170 CHAPTER 2016-194 Committee Substitute for Committee Substitute for Senate Bill No. 1170 An act relating to health plan regulatory administration; amending s. 112.08, F.S.; authorizing local governmental

More information

2. What kinds of insurance policies are covered by the Texas Guaranty Association?

2. What kinds of insurance policies are covered by the Texas Guaranty Association? The following information is intended to answer common questions about the Texas Life & Health Insurance Guaranty Association (the Texas Guaranty Association ) and the coverage it provides to policyholders

More information

Welcome to the International Classification of Diseases, ninth revision (ICD-9) Requirements Frequently Asked Questions (FAQ) course.

Welcome to the International Classification of Diseases, ninth revision (ICD-9) Requirements Frequently Asked Questions (FAQ) course. Welcome to the International Classification of Diseases, ninth revision (ICD-9) Requirements Frequently Asked Questions (FAQ) course. 1 Disclaimer While all information in this document is believed to

More information

MEDICARE AND MEDICAID AVOIDING POST-JUDGMENT AND POST-SETTLEMENT LITIGATION WORKERS COMPENSATION AND MEDICARE SET ASIDE ISSUES

MEDICARE AND MEDICAID AVOIDING POST-JUDGMENT AND POST-SETTLEMENT LITIGATION WORKERS COMPENSATION AND MEDICARE SET ASIDE ISSUES MEDICARE AND MEDICAID AVOIDING POST-JUDGMENT AND POST-SETTLEMENT LITIGATION WORKERS COMPENSATION AND MEDICARE SET ASIDE ISSUES INTRODUCTION Over the last 10 years workers compensation practitioners have

More information

Medicare in Personal Injury Claim Settlements: Complying with Reporting Requirements and Satisfying Liens

Medicare in Personal Injury Claim Settlements: Complying with Reporting Requirements and Satisfying Liens Presenting a 90-Minute Encore Presentation of the Teleconference with Live, Interactive Q&A Medicare in Personal Injury Claim Settlements: Complying with Reporting Requirements and Satisfying Liens TUESDAY,

More information

Questions On Charges For The Uninsured. Q1: Can a hospital waive collection of charges to an indigent, uninsured individual?

Questions On Charges For The Uninsured. Q1: Can a hospital waive collection of charges to an indigent, uninsured individual? 2/17/04 2:11 pm Questions On Charges For The Uninsured Q1: Can a hospital waive collection of charges to an indigent, uninsured individual? A1: Yes. Nothing in the Centers for Medicare & Medicaid Services

More information

Specifically, section 6035 of the DRA amended section 1902(a) (25) of the Act:

Specifically, section 6035 of the DRA amended section 1902(a) (25) of the Act: DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 Medicaid and CHIP FAQs: Identification of Medicaid

More information

EMPLOYEE BENEFITS LIABILITY COVERAGE

EMPLOYEE BENEFITS LIABILITY COVERAGE POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 04 35 12 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYEE BENEFITS LIABILITY COVERAGE THIS ENDORSEMENT PROVIDES CLAIMS-MADE COVERAGE.

More information

LEGISLATIVE BILL 951

LEGISLATIVE BILL 951 LEGISLATURE OF NEBRASKA ONE HUNDRED THIRD LEGISLATURE SECOND SESSION LEGISLATIVE BILL Introduced by Lautenbaugh,. Read first time January, 0 Committee: Business and Labor A BILL FOR AN ACT relating to

More information

Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE

Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE Chapter I: INTRODUCTION AND OVERVIEW

More information

Medicare, Medicaid & Private (Employer-Provided) Health Insurance Plans

Medicare, Medicaid & Private (Employer-Provided) Health Insurance Plans Medicare, Medicaid & Private (Employer-Provided) Health Insurance Plans Medicare, Medicaid & Private (Employer-Provided) Health Insurance Plans IMPORTANT INFORMATION ABOUT HEALTHCARE LIENS IN PERSONAL

More information

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 A (Ed. 4-92) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY PLEASE READ THE POLICY CAREFULLY. QUICK REFERENCE BEGINNING ON PAGE INFORMATION PAGE GENERAL SECTION... 2 A. The Policy...

More information

A BILL FOR AN ACT ENTITLED: "AN ACT CREATING THE CATASTROPHIC HEALTH CARE COSTS ACT TO

A BILL FOR AN ACT ENTITLED: AN ACT CREATING THE CATASTROPHIC HEALTH CARE COSTS ACT TO HB0.0 HOUSE BILL NO. INTRODUCED BY A. WITTICH A BILL FOR AN ACT ENTITLED: "AN ACT CREATING THE CATASTROPHIC HEALTH CARE COSTS ACT TO ESTABLISH A STATE-FUNDED PROGRAM OF COVERAGE FOR CATASTROPHIC HEALTH

More information

H.B. 1869: The Impact of the Subrogation Reform Bill Upon Third-Party Liability Claims

H.B. 1869: The Impact of the Subrogation Reform Bill Upon Third-Party Liability Claims H.B. 1869: The Impact of the Subrogation Reform Bill Upon Third-Party Liability Claims Tasha Barnes Tasha Barnes Thompson Coe Cousins & Irons 701 Brazos, Suite 1500 Austin, TX 78701 tbarnes@thompsoncoe.com

More information

Structured settlements currently play an important role in compliance with Medicare s Secondary Payer Act.

Structured settlements currently play an important role in compliance with Medicare s Secondary Payer Act. August 14, 2012 Centers for Medicare & Medicaid Services Department of Health and Human Services ATTN: CMS-6047-ANPRM Room 445-G Hubert H. Humphrey Building 200 Independence Ave., SW Washington, DC 20201

More information

Chapter 10 Section 5

Chapter 10 Section 5 Claims Adjustments And Recoupments Chapter 10 Section 5 1.0 GOVERNMENT S RIGHT TO RECOVER MEDICAL COSTS The following statutes provide the basic authority for the recovery of medical costs incurred as

More information

CHAMPAIGN COUNTY NURSING HOME SUMMARY OF ANTI-FRAUD AND ABUSE POLICIES

CHAMPAIGN COUNTY NURSING HOME SUMMARY OF ANTI-FRAUD AND ABUSE POLICIES 1. PURPOSE CHAMPAIGN COUNTY NURSING HOME SUMMARY OF ANTI-FRAUD AND ABUSE POLICIES Champaign County Nursing Home ( CCNH ) has established anti-fraud and abuse policies to prevent fraud, waste, and abuse

More information

Date Completed: 3-5-02 RATIONALE

Date Completed: 3-5-02 RATIONALE MEDICARE SUPPLEMENT POLICY S.B. 748 (S-1) & 749 (S-1): FIRST ANALYSIS Senate Bill 748 (Substitute S-1 as passed by the Senate) Senate Bill 749 (Substitute S-1 as passed by the Senate) Sponsor: Senator

More information

MONTEFIORE HEALTH SYSTEM ADMINISTRATIVE POLICY AND PROCEDURE SUBJECT: SUMMARY OF FEDERAL AND STATE NUMBER: JC31.1 FALSE CLAIMS LAWS

MONTEFIORE HEALTH SYSTEM ADMINISTRATIVE POLICY AND PROCEDURE SUBJECT: SUMMARY OF FEDERAL AND STATE NUMBER: JC31.1 FALSE CLAIMS LAWS MONTEFIORE HEALTH SYSTEM ADMINISTRATIVE POLICY AND PROCEDURE SUBJECT: SUMMARY OF FEDERAL AND STATE NUMBER: JC31.1 FALSE CLAIMS LAWS OWNER: DEPARTMENT OF COMPLIANCE EFFECTIVE: REVIEW/REVISED: SUPERCEDES:

More information

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows: General Section A. The Policy

More information

ENROLLED HOUSE BILL No. 4455

ENROLLED HOUSE BILL No. 4455 Act No. 204 Public Acts of 2012 Approved by the Governor June 26, 2012 Filed with the Secretary of State June 27, 2012 EFFECTIVE DATE: June 27, 2012 Introduced by Rep. Shaughnessy STATE OF MICHIGAN 96TH

More information

Prepared by Whitney L. Teel, Esq.

Prepared by Whitney L. Teel, Esq. New Medicare Notice And Reporting Regulations: A Discussion On How To Settle Cases Without Exposing Clients To Penalties Under The Medicare Secondary Payer Act Prepared by Whitney L. Teel, Esq. I. Introduction

More information

NEGOTIATING WITH MEDICARE AND MEDICAID

NEGOTIATING WITH MEDICARE AND MEDICAID NEGOTIATING WITH MEDICARE AND MEDICAID I. MEDICARE PROVIDES HEALTHCARE COVERAGE A. Persons 65 Years Old and Older B. Certain Disabled Persons under 65 C. Persons with End-Stage Renal Disease II. MEDICARE

More information

Submitting Settlement Information Monday, July 13, 2015. Slide 1 - of 21

Submitting Settlement Information Monday, July 13, 2015. Slide 1 - of 21 Slide 1 - of 21 Welcome to the Medicare Secondary Payer Recovery Portal (MSPRP) Submitting Settlement Information course. As a reminder, you may view the slide number you are on by clicking on the moving

More information

North Carolina Interlocal Risk Management Agency (NCIRMA) Workers Compensation and Employers Liability Insurance Policy

North Carolina Interlocal Risk Management Agency (NCIRMA) Workers Compensation and Employers Liability Insurance Policy North Carolina Interlocal Risk Management Agency (NCIRMA) Workers Compensation and Employers Liability Insurance Policy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY QUICK REFERENCE Beginning

More information

Liens: Workers' Compensation, Medicare, Medicaid, ERISA & DPW

Liens: Workers' Compensation, Medicare, Medicaid, ERISA & DPW Liens: Workers' Compensation, Medicare, Medicaid, ERISA & DPW Presented by: Daniel J. Siegel, Esquire Law Offices of Daniel J. Siegel, LLC Integrated Technology Services, LLC 66 West Eagle Road Suite 1

More information