55 Ferncroft Road Suite 201
Danvers, MA 01923

(866) 630-CPSC Toll-free
(978) 774-0540 Facsimile

www.CPSCmsa.com

55 Ferncroft Road Suite 201
Danvers, MA 01923

(866) 630-CPSC Toll-free
(978) 774-0540 Facsimile

www.CPSCmsa.com

In response to concerns arising from the impact of the newly-passed Medicare, Medicaid, and SCHIP Extension Act of 2007, leading Medicare Secondary Payer (“MSP”) compliance provider, Crowe Paradis Services Corporation (“CPSC”), reaffirmed today that its comprehensive approach to the MSP statute already addresses the subject matter of Medicare’s new penalties. Having anticipated broader enforcement, CPSC is uniquely positioned to immediately provide MSP-compliance services for all the types of insurance settlements detailed in the new legislation.

The recently-passed law contains provisions amending the MSP statute; establishing new reporting requirements for all liability, self-insured, no fault, and workers’ compensation insurers. Under the law, these insurers now must determine whether a claimant / plaintiff is entitled to Medicare, and if so, report the case to Medicare once the “claim is resolved through settlement, judgment, award or other payment.” Companies who fail to meet the new requirements will face penalties of $1,000 per day per claimant.

“The implementation of this significant civil penalty should remove any doubt that all insurers need to have a comprehensive MSP-compliance protocol in place, not just a Medicare Set Aside (“MSA”) service,” said Kenneth J. Paradis, Esq., CPSC Chief Executive Officer.

Prompted by the enforcement of the Medicare Secondary Payer Statute in 2001, an industry of MSA providers have focused solely on the aspect of the compliance that requires money to be set aside for future Medicare-covered expenses. These MSA providers have either entirely ignored or made optional a process which addresses past “conditional payments” of Medicare liens that are also part of MSP compliance.

“Our emphasis on full MSP compliance rather than piecemeal MSA work has meant that we have been taking care of this statutory requirement for all of our clients since our inception,” said Paradis. “Unlike many of our competitors, we did not wait for civil penalties to add teeth to this long-standing Federal statutory requirement to take conditional payments seriously.” He adds, “The new amendments make clear that compliance with half the MSP statute is simply not enough for CMS; you have to address the conditional payments before they become liens.”

Robert T. Lewis, Esq., Chief Legal Officer and Vice President of Sales, highlighted that the new legislation underscores the need to weave CPSC’s current approach into a broader claim protocol on all workers’ compensation and liability cases before they are settled. “The new requirements underscore the importance of determining conditional payments as part of an overall settlement strategy on all cases to ensure compliance and protection from future litigation or penalties,” said Lewis. “It will be essential to have a compliance protocol in advance of the enactment date so that settlements are not delayed,” said Lewis.

“We have been successfully employing similar protocols for all of our workers’ compensation clients over the past several years. With our experienced staff of attorneys and nurses, we are uniquely positioned to assist clients in designing and implementing internal protocols to ensure compliance with the Act,” said Paradis. CPSC’s unique qualifications include:

• Former Medicare Recovery Contractors on staff to quickly determine and negotiate conditional payment claims.

• Former SSDI database developers on staff to quickly determine SSDI/Medicare entitlement status and properly report all applicable claims.

• Liability, Workers’ Compensation, and Social Security Disability attorneys on staff to address

with Medicare any mitigating issues involved in the underlying case.

• A founder and current President of the National Alliance of Medicare Set-Aside Professionals who was one of the architects of the certification for the industry.

• Certified utilization review nurses and life care planning nurses with decades of workers’ compensation experience and years of MSP compliance experience.

• A former Special Assistant Attorney General for the Massachusetts Workers’ Compensation Trust Fund and Chief of Staff for the Massachusetts Department of Labor.

Crowe Paradis Services Corporation is a national MSP compliance firm with offices in Atlanta, Boston, Chicago, Indianapolis, Kansas City, Los Angeles, Philadelphia, San Francisco, and Tampa. Please contact us directly at: 1-(866)-630-CPSC (2772) or via the web at sales@cpscmsa.com to speak with one of our knowledgeable professionals.

Rob Lewis’ article in DRI’s “For the Defense” anticipates enforcement of the conditional payments

If you are looking for ideas for a protocol in response to the new penalties attached to the Medicare, Medicaid, and SCHIP Extension Act of 2007, our own Robert Lewis co-authored an article in the Fall 2007 issue of DRI’s “For the Defense” with Mary Jane Ford of AIG entitled “Liability Settlements – Are Your Ducks in a Row: Meeting Your Statutory Duties to Medicare and Your Client.” This article is especially helpful if you are looking for a protocol that translates the MSP to the current requirements for liability, no-fault, medical malpractice, and other non-workers’ compensation related settlements. Here is a segment from the article:

When looking to find the right MSA vendor, you should ask the following questions:

• Does the vendor have lawyers on staff to address issues raised in liability claims that would impact the MSA amount?

• Has the vendor ever submitted a MSA to CMS for approval in a liability case?

• What is the turnaround time for CMS approval in liability cases? In workers’ compensation claims?

• What is the turnaround time for doing a MSA evaluation or cost projection?

• How does the vendor handle pharmaceutical costs?

• How long does it take for the vendor to confirm Social Security and/or Medicare status?

• Does the vendor negotiate conditional payment claims by Medicare?

For more information on this article, please visit our website at http://www.cpscmsa.com/news.html

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