Category Archives: LMSA

LMSA, Medicare Conditional Payments, Medicare Set Aside

A recent opinion out of the Eastern District of New York, Sexton v. Medicare, 2016 U.S. Dist. LEXIS 89815 (July 11, 2016), found that a Plaintiff cannot refute or defeat Medicare’s ability to recover conditional payments until the primary payer has demonstrated responsibility through a settlement, judgment or award. The brief facts involved Plaintiff Kevin Sexton (“Plaintiff”) being struck by …
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CMS Considering LMSA Review Process

10 Jun 2016 Heather Sanderson No Comments

Blog, LMSA

CMS issued an Alert yesterday which states: The Centers for Medicare and Medicaid Services (CMS) is considering expanding its voluntary Medicare Set-Aside Arrangements (MSA) amount review process to include the review of proposed liability insurance (including self-insurance) and no-fault insurance MSA amounts. CMS plans to work closely with the stakeholder community to identify how best to implement this potential expansion. …
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Blog, LMSA, Trial Practice

Legal Practitioners continue to seek guidance from Courts in absence of Centers for Medicare & Medicaid Services (CMS) rules on how to protect Medicare’s interest in a liability settlement.  We field calls every day from frustrated attorneys and claim handlers because of their concern about taking the right action to protect Medicare’s interests post-settlement.  CMS’ withdrawal of the NPRM on …
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Blog, LMSA, Medicare Secondary Payer News

Click here to read the recent Computation of Annual Liability Insurance (Including Self-Insurance) Settlement Recovery Threshold report that was submitted to the Congress pursuant to Section 202 of the SMART Act.

Blog, LMSA, Medicare Set Aside

Last week the Centers for Medicare & Medicaid Services (CMS) withdrew its proposed regulation for future medicals with respect to liability claim settlements. The Notice of Proposed Rulemaking (NPRRM) was submitted to the Office of Management & Budget over a year ago on August 1, 2013. The CMS submission can be found here. The NPRM was expected to cover how …
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Blog, LMSA

What a waste of time.  In Tye v. Upper Valley Medical Center, the parties held up a settlement for almost two years because of the defendant’s insistence of a Medicare Set Aside.  This case involved a medical malpractice settlement that occurred on July 21, 2012.  It was a personal injury settlement, that was “conditionally dismissed without prejudice until such time …
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Blog, LMSA

Many times we are asked when CMS will issue regulations related to protecting Medicare’s interest in a liability case.  The short answer is: No person outside of CMS really knows.  Thus far, CMS has taken the following steps toward possible rule-making.  1) Issued a Policy Memo on Future Medicals and Liability Claims, on September 30, 2011, that does not explain …
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LMSA Rulemaking Coming?

31 Jul 2013 Jeff Signor No Comments

Blog, LMSA

Medicare Plans to issue a Notice of Proposed Rule Making with regard to protecting Medicare’s interest in a liability case this coming September.  Click here: http://tinyurl.com/mmed9tr.  According to the regulatory calendar, the Centers for Medicare & Medicaid Services (CMS) is poised to issue the rule which would allow stakeholders a period of 60 days before it would move toward the final rule …
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An Excellent Method to Properly Reduce the LMSA

22 Apr 2013 Roy Franco No Comments

Blog, LMSA

Whether you have participated in the Centers for Medicare & Medicaid Services (“CMS”) Town Hall Conferences, or read the recent court decisions on confirming the Liability Medicare Set Aside (“LMSA”) it is abundantly clear that CMS does not currently require, approve or have a stated policy regarding the LMSA – yet CMS states unequivocally its interests must be protected.  How …
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LMSA

A few weeks ago, the Superior Court for the State of Connecticut in the Judicial District of Litchfield was presented with a Motion by the Plaintiff to “Determine that the Parties Have Reasonably considered Medicare’s Interests As Required by the Medicare Secondary Payor (sic) Act, 22 U.S.C. §1395v”.  All parties joined the Motion and the Court granted it.  The Centers …
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