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Humana Alleges Retailer’s Reliance and Lack of Follow-up to Ensure Medicare Beneficiary Plaintiff Reimburses Medicare Part C for Conditional Payments is Actionable for Double Damages under the MSP

29 Aug, 2018 Heather Schwartz Sanderson

Humana is continuing on its mission to establish precedent across the country regarding Medicare Advantage Plans’ (MAPs) ability to pursue a Medicare Secondary Payer (MSP) double damages private cause of action against primary plans that […]

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    Overcoming the Odds: Empowering Injured Workers on the Road to Recovery

    Workplace injuries can be life-altering, burdening individuals physically, emotionally, and financially. While workers’ compensation programs aim to support injured workers, the journey to recovery can be grueling. This article will explore the challenges injured humans […]
    CMS Significantly Expands Amended Review MSA Availability

    The Centers for Medicare and Medicaid Services (CMS) announced the expansion of its Amended Review policy to significantly more MSAs in the latest update to its WCMSA Reference Guide, Version 3.9. The Amended Review process was […]
    Our Current State Fails to Attract the Next Generation

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    About The Author

    • Heather Schwartz Sanderson

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    Evidence-Based Medicine Results in Optimal Clinical Outcomes: Why Potentially Lowering Your Medicare Set-Aside (MSA) is Just a Secondary Benefit

    Evidence-based medicine (EBM) is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”[1] The aim of EBM is to integrate the experience of the clinician, the values […]
    Sanderson Firm Welcomes Leesa Rice as Executive Vice President, Business Development

    Bradenton, FL (WorkersCompensation.com) – Sanderson Firm PLLC, a Medicare Secondary Payer (MSP) Compliance law firm, is pleased to announce the appointment of Leesa Rice as Executive Vice President, Business Development. Rice brings with her over […]
    Why Timely Ongoing Responsibility for Medical (ORM) Termination is so Important in MMSEA Section 111 Reporting

    If you work with workers’ compensation or no-fault/auto claims involving Medicare beneficiaries, you should be familiar with Ongoing Responsibility for Medical (ORM) as a requirement of MMSEA Section 111 Reporting. According to the NGHP User […]

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    Overcoming the Odds: Empowering Injured Workers on the Road to Recovery

    Workplace injuries can be life-altering, burdening individuals physically, emotionally, and financially. While workers’ compensation programs aim to support injured workers, the journey to recovery can be grueling. This article will explore the challenges injured humans […]
    CMS Significantly Expands Amended Review MSA Availability

    The Centers for Medicare and Medicaid Services (CMS) announced the expansion of its Amended Review policy to significantly more MSAs in the latest update to its WCMSA Reference Guide, Version 3.9. The Amended Review process was […]
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    The Postman Rings?

    It all started when some fellow from the federal government showed up at my office. We were initially surprised and somewhat taken aback. He explained that response is not uncommon. He was here to bring […]
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    By Dr. Claire Muselman and Nate Ferguson Productivity is paramount in the demanding world of workers’ compensation claims adjusting. The adjusting desk is responsible for imperative components impacting the lives of injured human beings in […]
    The Impact of Psychosocial Issues on Injured Workers

    In the wake of the COVID-19 pandemic, many individuals experienced feelings of isolation, loneliness, and loss of connection. However, injured workers also experience these psychosocial issues, including anxiety, fear, financial insecurity, and relationship challenges, from […]

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