Resolving Medicare Conditional Payment Obligations

AI, Medicare, and the Rising Stakes in Personal Injury Settlements

Goodbye Chevron deference: What does this mean for Medicare Secondary Payer compliance?

By: Rasa Fumagalli, JD, MSCC, CMSP-F
The United States Supreme Court overruled the Chevron doctrine in the recent case of Loper Bright Enterprises et al v Raimondo , Secretary of Commerce , et al. ( No. 22-451, 604 U.S. ____(2024)22-451). …
CMS’ Data Driven Approach to MSP Compliance

Rasa Fumagalli, JD, MSCC, CMSP-F
It is well established that parties to a settlement involving a current Medicare beneficiary should consider Medicare’s potential interest in the settlement. This interest comes from the Medicare Secondary Payer (“MSP”) Act and supporting regulations which …
Synergy’s Workers’ Compensation Medicare Secondary Payer Advice Column

June 6, 2023
Rasa Fumagalli JD, MSCC, CMSP-F
The Medicare Secondary Payer Act impacts workers’ compensation, liability, and no-fault settlements involving a Medicare beneficiary. This month’s “Since You Asked” column addresses a situation where Medicare incorrectly denies non-injury-related treatment after …
Synergy’s Workers’ Compensation Medicare Secondary Payer Advice

February 14, 2023
Rasa Fumagalli, JD, MSCC, CMSP-F
Oftentimes an attorney representing an injured worker may simply scan the defense’s Medicare Set-Aside and assume all the future medical issues have been addressed in the MSA. This month’s “Since You Asked” …
How Does Medicare Decide Which Payments Are Conditional?

February 9, 2023
Rasa Fumagalli, JD, MSCC, CMSP-F
Settlements involving Medicare beneficiaries require additional scrutiny to ensure compliance with the MSP Act. While the Act generally prohibits Medicare from making payment when payment is expected from a primary payer (workers’ …
Complying with the Medicare Secondary Payer Act When a Client has Public Benefits

August 11, 2022
Evelynn Passino, J.D.
For clients with public benefits, closing out their case is not as simple as issuing a check for their net recovery. If the client has Medicare or will be eligible soon, then steps must …
Is it Workers’ Compensation or Liability?

July 21, 2022
Rasa Fumagalli, JD, MSCC, CMSP-F
Netflix’s new baking competition show “Is it Cake” challenges judges to identify which of two identical objects is edible and which is not. Attorneys settling cases involving work-related injuries may find themselves …
Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide

March 24, 2022
Rasa Fumagalli JD, MSCC, CMSP-F
The Centers for Medicare and Medicaid Services (CMS) issued Version 3.6 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (“Guide”) on March 15, 2022. It softened the language …