Category Archives: Medicare Set Aside

Franco Signor News, Medicare Secondary Payer News, Medicare Set Aside, Uncategorized

Franco Signor’s Chief Legal Officer, Roy Franco, has been prominently featured in a new article over at businessinsurance.com. The “in-depth” article covers the Medicare Secondary Payer Act from a number of angles. Mr. Franco’s unmatched expertise in this area continues to make him a leader in the industry. We invite you to read this important and timely article. CLICK HERE …
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Blog, Medicare Conditional Payments, Medicare Set Aside

Alexander v. Laborde,et. al., Court of Appeal of Louisiana, Third Circuit. (2012) Many times we are asked about protecting Medicare’s interest in a trial setting.  The defendant is usually concerned about exposure after being required to pay over a lump sum to the plaintiff without any ability to direct payment to protect Medicare.  We have found the best way to …
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Blog, LMSA, Medicare Set Aside

An article recently published in The Brief (Fall 2012), within the Tort Trial & Insurance Practice Section of the American Bar Association, may lead the reader to draw the wrong conclusion about how to protect Medicare’s interest when settling a general liability claim.  The implication in that article, “Medicare Set-Aside Arrangements Under the Medicare Secondary Payer Act”, is that if …
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Blog, LMSA, Medicare Set Aside

Finke v. Hunter’s View, 2009 U.S. dist. LEXIS 126830 (U.S. Dist. Court for Dist. of Minnesota, 5th Division) Facts:  Claimant was paralyzed when he fell from a ladder.  He sued the manufacturer (including the purported retailer) for defective design.  The case settled for $1.5M.   Prior to settlement, Claimant was dual eligible for benefits under Medicaid and Medicare.   Claimant lost his …
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Blog, LMSA, Medicare Set Aside

Cribb vs. Sulzer Metco (US) Inc. – 2012 – U.S. Dist. Court for Eastern Dist. of NC Facts:  Plaintiff, a Medicare beneficiary, settled his claim with Defendant.  Concerned over how to protect Medicare’s interest, Plaintiff filed a Motion in U.S. District court seeking Approval of Settlement and Determination of Need for and Amount of Medicare Set Aside.    Notice was provided …
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Blog, LMSA, Medicare Set Aside

Facts:  Plaintiff, a crane mechanic, was injured on the job.  In addition to his workers’ compensation claim, he presented a claim against the owner/operator of the liftboat he was working on.  He settled his liability claim for $785,000 and agreed to pay $82,500 of it to his employer’s workers’ compensation carrier in exchange of a waiver of their lien against …
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Blog, Medicare Set Aside, WCMSA

Katie A. Fox, MSCC – VP Medicare Compliance On August 1, 2012 CMS released yet another Memorandum providing guidance to MSA Allocators, as it pertains to pricing for Transcutaneous Electrical Nerve Stimulation (TENS) units included within submitted Workers’ Compensation Medicare Set-Aside (WCMSA) proposals.   CMS has defined Chronic Low Back Pain (CLBP) as the following: “an episode of low back …
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Blog, Franco Signor News, LMSA, Medicare Secondary Payer News

The Centers for Medicare & Medicaid Services (CMS) published its request for public comment on possible rules being  considered  for liability settlements involving future medicals this past June.   Franco Signor submitted its response to the Advanced Notice of Proposed Rulemaking (CMS-6047-ANPRM) last week.  To review our commentary, click here.    Our response was designed with two objectives in mind.  First, to …
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Blog, LMSA, Medicare Set Aside

Sipler v. Trans Am Trucking, Inc., et al., 2012 US Dist. LEXIS 109278 (U.S. Dist. Court for New Jersey, 7/24/2012). Facts: (Highlights): A settlement was reached for $225,000 on the eve of trial; No other terms were discussed at the time of settlement The injured plaintiff had recently become eligible for  Medicare benefits, but Medicare did not pay  because incident-related medical …
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Lyrica: No Brand-Name Swansong

27 Jul 2012 Roy Franco No Comments

Medicare Conditional Payments, Pharma Part D, WCMSA

Lyrica is one of the most expensive chronically prescribed drugs used in workers compensation spine/back cases. Lyrica is a anticonvulsant drug used to treat chronic neuropathic back or spine pain, such as pain in a leg that persists after a lumbar spine injury. Prior to Lyrica, Gabapentin had been the primary anticonvulsant drug used for neuropathic pain, and its cost …
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