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Through an integrated medical, pharmacy, claims and legal approach, we deliver insights to help navigate the ever‑changing Medicare Secondary Payer landscape.

Recent blog posts

July 27, 2020 · Lavonya Chapman, Associate General Counsel, Optum Settlement Solutions
The U.S. Circuit Court of Appeals recently ruled that Medicaid may seek to recover payments it made for an eligible recipient’s treatment from the settlement agreement that released both past and future medical care ― Gallardo v. Dudek, 2020 U.S. App. LEXIS 19928. The 11th Circuit used the U.S. Supreme Court’s decision in Arkansas Dept. of Health and Human Svcs. v. Ahlborn, 547 U.S. 268 (2006) in reaching the Gallardo decision. Read more...
July 22, 2020 · Lavonya Chapman, Associate General Counsel, Optum Settlement Solutions
The Centers for Medicare and Medicaid Services (CMS) recently alerted stakeholders that they updated the requirements for reporting auto no-fault claims in the Non-group Health Plan (NGHP) Section 111 User Guide. This update affects responsible reporting entities (RRE) and associated third-party claims administrators (TPA) who insure or manage No-Fault auto claims and are required to report to CMS under the Medicare Secondary Payer (MSP) Mandatory Reporting Provisions Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of 2007. Read more...
July 13, 2020 · Lavonya Chapman, Associate General Counsel, Optum Settlement Solutions
The Centers for Medicare & Medicaid Services (CMS) recently revised the timeline and abstract noted in the Spring 2020 Unified Agenda. Updated by the Office of Management and Budget, when published, this revision will impact workers’ compensation, liability, and no-fault claims. Read more...
May 24, 2020 · Optum Settlement Solutions
The Centers for Medicare and Medicaid Services (CMS) released an updated Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide , Version 3.1., dated May 11, 2020 Read more...
May 05, 2020 · Optum Settlement Solutions
The Centers for Medicare and Medicaid Services (CMS) wants their money back and is going after payers to get conditional payments reimbursed. CMS has been sending notices to payers demanding payment, but many of the notices are going unanswered. That creates a two-fold problem. Interest accrues on the balance, and if there’s no response, the U.S. Treasury could seize the assets of the payer (i.e., carrier or self-insured employer). Read more...
April 10, 2020 · Optum Settlement Solutions
The Workers' Compensation Medicare Set-Aside Portal (WCMSAP) is updated monthly based on Average Wholesale Price (AWP) data from RED BOOK®.  Updates include a significant drop in the price of pregabalin (generic of Lyrica®), and a substantial decrease in the price of meloxicam (generic of Mobic®). Read more...
April 09, 2020 · Optum Settlement Solutions
As you may have heard, meloxicam had a major price decrease within the last month. Meloxicam (generic formulation of Mobic) is a non-steroidal anti-inflammatory (NSAID), which is commonly prescribed for workers’ compensation injuries. Read more...
March 03, 2020 · Optum Settlement Solutions
Medications comprise a large proportion of Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs). And, as the population ages, more claimants will become eligible for Medicare coverage. So, it is important to stay up-to-date on medication costs and how they affect WCMSAs. Read more...
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