blackburn group inc.

January 2012

The Department of Health and Human Services (HHS) Announces a Plan to Prevent Prescription Medication Fraud

In December, the Obama Administration announced recovery of over $5.6 billion in fraudulent payments in fiscal year 2011, a 167 percent increase from 2008. President Obama's health care reform law includes new resources and tools to help fight fraud in Medicare and Medicaid, and to protect taxpayer dollars. Additionally, the Centers for Medicare and Medicaid Services (CMS) are taking steps to strengthen controls to identify and prevent prescription drug fraud and abuse in the Medicare Part D program.

CMS released a notice to Part D prescription drug plan sponsors that contains information and guidance to immediately take steps to stop prescription drug misuse and fraud. Pain killers like OxyContin are the fifth most filled classes of drugs in Medicare, with spending in 2009 totaling $3.9 billion. Recently, the Government Accountability Office identified evidence of fraud and drug abuse in Medicare for these types of drugs, which pose a threat to public health as well as the federal budget.

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New MMSEA Section 111 NGHP User Guide Version 3.3 Now Available

The Centers for Medicare and Medicaid Services (CMS) has published an update to the Liability Insurance (Including Self-Insurance), No Fault Insurance and Workers' Compensation User Guide (dated December 16, 2011) for Medicare Set Asides adding information about invalid E-codes, profile reports, typographical corrections, and published alerts about the pre-December 5, 1980 claims and mass torts.

Why do you need written consent of the Beneficiary (Claimant) to secure most Medicare Conditional Lien and Final Demand Letters?

The U.S. Department of Health and Human Services (HHS) established The Privacy Act of 1974 which protects records that can be retrieved by personal identifiers such as a name, social security number, or other identifying number or symbol. An individual is entitled to access to his or her records and to request correction of these records if applicable. The Privacy Act prohibits disclosure of these records without the written consent of the beneficiary (Claimant) to whom the records pertain unless one of the twelve disclosure exceptions enumerated in the Act applies.

When Medicare is the Secondary Payer for all types of Liability Insurance, No-Fault Insurance, Self-Insurance, or Workers' Compensation claims always be sure to secure the appropriate MSPRC / CMS Consent to Releases in order to obtain the necessary information you need in order to protect yourself under the law.

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