Synergy Blog

Ahlborn is Alive & Well

Since the landmark decision by the US Supreme Court in Arkansas Department of Health and Human Services v. Ahlborn in 2006, state Medicaid agencies have grappled with how to recover monies spent for injury related care through their third party liability statutes without violating the Ahlborn decision.  Many states continued to apply third party recover…

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Turn to Synergy in 2018

It is a New Year and time to experience the power of Synergy. Synergy allows trial lawyers to focus on what they do best by handling the difficult issues at settlement such as lien resolution, Medicare Secondary Payer Compliance, public benefit preservation, settlement planning (including tax-free structured settlements) and tax deferral of contingent legal fees….

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Limitations on Hospital/Provider Liens When the Plaintiff is on Medicare

By David L. Place, J.D. One of the most difficult issues trial counsel must resolve involves addressing hospitals/providers liens for Medicare clients.   Recently the Centers for Medicare and Medicaid Services (CMS), via the Medicare Learning Network (MLN), released policy memo SE17018 which provides excellent and concise answers to most of these issues. This memo addresses when…

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Liability Medicare Set Asides (LMSAs): October is Here! Now What?

By B. Josh Pettingill, MBA, MS, MSCC & Jason D. Lazarus, J.D., LL.M., MSCC The debate regarding addressing Medicare’s future interest in liability settlements is filled with nuance and subtleties. An essential step in understanding the big picture is starting with the genesis of set asides, the Medicare Secondary Payer (MSP) Statute. Although, the finer…

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Total “Medicare” Compliance in a New Age

By Jason D. Lazarus, J.D., LL.M., MSCC “Although the statute is structurally complex—a complexity that has produced considerable confusion among courts attempting to construe it—the MSP’s function is straightforward.” US v. Baxter Intern., Inc., 345 F. 3d 866 (11th Cir. 2003). Attorneys are consistently exposed to liability risks when handling cases for Medicare beneficiaries. This…

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CMS Gearing Up to Reject Medicare Claims Related to Liability Settlements: LMSAs on the Horizon

By B. Josh Pettingill Last week, the Centers for Medicare and Medicaid Services (CMS) released a “CMS Manual System” “One-Time Notification” regarding Liability Medicare Set Asides and enforcement of the Medicare Secondary Payer statute (MSP). Starting October 1, 2017, Medicare and their contractors will reject medical claims submitted post-resolution of a liability settlement on the…

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Supreme Court Rejects Change in Lien Res. Outsourcing

After nearly five years, on October 6, 2016, the Florida Supreme Court issued Opinion SC16-104 and declined to make any change to the existing Rules Regulating the Florida Bar in relation to lien resolution outsourcing. As Florida’s trial attorneys know, the issue of whether there was a need for a change in the existing rules…

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Medicare Reduces Reporting Threshold from $1,000 to $750

Medicare has reduced the threshold for when a physical trauma-based liability settlement is large enough that the beneficiary needs to report it and repay conditional payments. On November 15, 2016, the Centers for Medicare & Medicaid Services (“CMS”) issued an alert which decreased the current reporting threshold from $1,000 to $750. The threshold decrease is…

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A Day in the Life

By Anthony F. Prieto, Jr., CFP® I consider myself to be a very fortunate person. I have a supportive family and friends. I have a job that allows me to meet, and more importantly help, great people who are in need on a daily basis. I was recently asked what is Synergy and what do…

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Damages “shall” be in an amount double… Medicare Advantage Plans

By David L. Place, J.D. On Monday, August 8th, the 11th Circuit affirmed the decision of the Southern District of Florida to award a Humana Medicare Advantage plan double damages when they were not repaid at the conclusion of a personal injury action. In Humana Medical Plan, Inc. v. Western Heritage Ins. Co., No. 15-11436 (11th…

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