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Article
Opioid reserves in Medicare set-asides a nationwide problem

Sedgwick SVP Medicare Compliance, Michael Merlino is featured in an article that focuses on how Medicare set-asides with money earmarked for opioids is drawing national attention. Mr. Merlino explains Medicare set-asides and the green light for future prescriptions that accompany the cash are the responsibility of the injured workers and their treating physicians. As part of the process for closing a claim with a Medicare set-aside, the U.S. Centers for Medicare and Medicaid Services must appr

Blog
Centers for Medicare & Medicaid Services (CMS) retains new review contractor

On September 1, CMS hired Capitol Bridge, LLC to be the new review contractor for MSAs. According to CMS employees that we’ve spoken to, the transition is currently underway. The old contractor is staying on for an indeterminate amount of time to help with the transition. We expect the transition will take anywhere from 60 to 90 days. Based on our prior experience with a change in MSA review contractors, this may have a significant impact on CMS approved MSAs. First, we expect that CMS will s

Blog
It is happening: LMSAs (and NFMSAs) are almost here

For the past several years, the Centers for Medicare & Medicaid Services (CMS) has been providing the industry with vague hints about liability Medicare set-aside arrangements (LMSAs). The absence of clarity left the liability community unable to know how Medicare set-aside arrangements (MSAs) would apply in a liability setting. Earlier this month, CMS released a communication to providers, physicians and suppliers indicating that LMSAs and no-fault Medicare set-aside arrangements (NFMSAs)

Blog
Could you cut $185,000 from your MSA?

What if I told you that you could save $185,000 at no cost to you? No, I am not advertising for some late night TV infomercial where the offer is too good to be true. I am talking about the world of Medicare set-asides (MSA). It is well known that prescription drugs are the leading cause of high MSAs. Why is that? The reason is simple: The Centers for Medicare & Medicaid Services (CMS) require drugs to be priced for the lifetime of the claimant (if we are seeking CMS approval of the MSA). In

Blog
Change, non-change important to Medicare compliance regulations

If you have been trying to keep up with the latest Medicare compliance changes, you might feel like you are watching the carnival vendor who used to say, “around and around it goes and where it stops nobody knows.” Fortunately, with these answers you don’t have to guess. Liability: CMS withdraws proposal for liability MSAsSometimes the biggest developments come from the changes that don't happen; this was the case for Medicare set-asides (MSAs) in liability cases. In 2012, the Centers for Med

Client bulletin
Medicare Bulletin - February 2014

Read the latest from Sedgwick’s Medicare compliance unit, including details on our new Medicare concierge service.

Blog
Moody's downgrade of U.S. health insurance sector - examining the causes

Speculation is rife about what will happen with healthcare in 2014. Now one of the first predictors has publicly voiced its opinion. On Wednesday, I read with great interest that Moody's revised its outlook for the U.S. healthcare sector to negative from stable. They based their ratings on expectations that changes in the competitive landscape and regulatory environment caused by the Affordable Care Act (ACA) will exert negative pressure on the sector. The rating agency points to the key provi

Blog
Managing the risks of ACOs

In any given week, a health care risk manager can find themselves involved in something new – investigating a patient injury, preparing a statement for a liability claim, educating staff on safety, assisting in designing risk transfer or financing strategy for the organization, or ensuring compliance of a new law or regulation. With the passage of healthcare reform, risk managers may feel the rules they previously understood to guide their jobs have changed. In reality, much will remain the sa

Client bulletin
Impact of the government shutdown on Medicare compliance

The ongoing shutdown of the U.S. federal government has had an adverse effect on numerous other agencies and departments.

Article
Smart Act Will Help Employers Avoid Large Noncompliance Fines

Michael explains that a slight wording change to the legislation could create big savings for smaller employers if they accidentally fail to report a Medicare-related claim settlement to the Centers for Medicare and Medicaid Services. He also talks about some of the provisions designed to decrease the uncertainty associated with the settlement process.

Client bulletin
Medicaid compliance challenges on the horizon

The Medicaid health program is a state/federal partnership that covers nearly 50 million low income Americans. The expansion of Medicaid under the Affordable Care Act (ACA) may result in increased expenditures for both the federal and state governments.

Client bulletin
U.S. Senate, House pass the SMART Act: Medicare compliance changes on the horizon

On December 21, 2012, we were very pleased to learn that, by a unanimous vote andjust one week after their counterparts in the U.S. House of Representatives, the U.S. Senate passed the Strengthening Medicare and Repaying Tax Payers (SMART) Act.

Client bulletin
Medicare Compliance Update-August

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