blackburn group inc.

October 2012

CMS Announcement on Medicare Set-Aside Approvals

Recently The Centers for Medicare and Medicaid Services (CMS) announced "please be assured that the Workers' Compensation Review Contractor (WCRC) is reviewing proposed WCMSA amounts submitted to CMS prior to July 2, 2012. We are confident that submitters, Medicare beneficiaries and other program stakeholders will soon begin to see an increase in CMS' communications regarding WCMSA proposals dated prior to July 2, 2012, and after. The CMS strives to provide all WCMSA stakeholders the best customer service possible; and CMS is continually working to improve the WCMSA process."

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Medicare Fraud Strike Force has Announced New Enforcement Action

On October 4, 2012, the Medicare Fraud Strike Force operations conducted in seven cities have charged 91 individuals – including doctors, nurses and other licensed medical professionals – for their alleged participation in Medicare fraud schemes involving approximately $430 million in false billing, Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced.

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MMSEA Section 111 Mandatory Data Reporting Enforcement Coming

On October 2, 2012, the U.S. Department of Health and Human Services Office of Inspector General released its Fiscal Year 2013 Work Plan where they announce their intent to determine whether "selected" Non-Group Health Plans (NGHPs) properly reported insurance coverage information to Medicare as required under the 2007 MMSEA Section 111 Mandatory Data Reporting Law. It appears that the federal government is prepared to audit for the Mandatory Reporting Compliance. As we know Mandatory Reporting leads to properly accounting for Conditional Payments and Medicare Set-Asides.

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