ECS on MSP
Expert Insight into the Latest News & Updates for Medicare Secondary Payer Compliance

Philadelphia U.S. Attorney Nets Another Recovery for Unpaid Medicare Debts
The U.S. Department of Justice (“DOJ”) is ringing in the New Year with the Medicare Secondary Payer Act (“MSPA”). On January 8, 2020, the U.S. Attorney’s Office for the State of Pennsylvania announced a $6,604.59 conditional payment settlement with Philadelphia firm Simon & Simon.

Yet Another Price Drop for Oxycodone/APAP Tablets
We previously shared a price update in August of regarding a widely used opioid-acetaminophen (oxycodone/APAP) combination product. Another price drop has been announced, and this time it is for all oxycodone/APAP tablet strengths, 5-325mg, 7.5-325mg and 10-325mg.

Updates from CMS Regarding NGHP Processes
CMS has posted two updates this week:
The Total Payment Obligation to the Claimant (TPOC) threshold for reporting Section 111 claims and for Conditional Payment recovery efforts will remain at $750 for the 2020 calendar year. The Alert is available here.
CMS will be hosting a town hall meeting on January 14, 2020 at 1pm EST to discuss common Commercial Repayment Center (CRC) Ongoing Responsibility for Medicals (ORM) recovery topics.

Ask Annie: Mythical Zero Allocations
A “zero allocation” is what we call not setting money aside to pay for a claimant’s post-settlement Medicare-covered medical needs. A zero allocation is possible in two situations.

CMS issues reminder related to Medicare Beneficiary Identifier (MBI) and NGHP Reporting
On November 18, 2019, CMS released an alert titled, “Important Reminder for Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs) Regarding Medicare Beneficiary Identifier (MBI)

OMB Updates Timeline Civil Money Penalty and Future Medical Regulations
That can? It’s still getting kicked. Earlier this week the White House Office of Management and Budget updated the timeline on the release of regulations

Baltimore U.S. Attorney Nabs Another Plaintiff’s Firm: Obtains $91,000 Settlement to Resolve Allegations a Firm Failed to Reimburse Medicare
As you may recall, we have been down this road before with a different Baltimore law firm and a Pennsylvania practitioner. Standard operating procedure when settling a personal

CMS Updates WCMSA Reference Guide: Key Changes in Store
Late on Tuesday October 29th the Centers for Medicare & Medicaid released an update, version 3.0 to its WCMSA Reference Guide (Guide). The new version of

Rolling Recovery of Conditional Payments Impacts Non-Closure States
Once again insurers and self-insured employers have been hit with a substantial amount of new paperwork from the Centers for Medicare & Medicaid Services (CMS).
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