Trial Lawyer Resource Center

From the AAJ:

 

EMERGENCY MEDICARE SET ASIDE INFORMATION

Dear Colleague:

       In cases involving Medicare beneficiaries, attorneys for both the plaintiff and defendant are required to report certain information to the Centers for Medicare and Medicaid Services (CMS).  In addition, any case settlement or judgment must reimburse Medicare where the Trust Fund has made conditional payments for medical costs.  Under the Medicare Secondary Payer Act, attorneys have been settling cases involving liability claims without completing a Medicare Set Aside (MSAs) to account for future medical costs.  However, attorneys representing claimants in workers' compensation cases have been preparing MSAs on a case-by-case basis.

       It has come to our attention that some defense firms and insurance providers are now claiming that CMS requires MSAs in liability cases pursuant to Section 111 reporting requirements included in the Medicare, Medicaid & SCHIP Act of 2007 (MMSEA), Public Law No. 110-173.  This is false.  Section 111 contains reporting requirements for responsible reporting entities(1)  (RREs) only.  Section 111 does not impact or change the requirements for plaintiffs' attorneys.

       Moreover, statements from CMS, and other federal entities, make clear that the agency does not require set-asides for liability claims.  Since the MMSEA's passage, CMS has held several Town Hall teleconferences to discuss the Section 111 requirements.  During the March 24, 2009 call, Barbara Wright, CMS' Acting Director of the Division of Medicare Debt Management, made several statements reiterating that Section 111 has no impact on liability MSAs.(2)   For example:

• In response to a question as to whether liability set-asides will be required under Section 111, she said "the point is the set-aside process is totally separate from the Section 111 reporting process.  As we've said in more than one call we don't anticipate changing our routine recovery process."  (Transcript, pg. 24)
   
• When explaining that worker's compensation agreements use a formal review process which makes set-asides recommended, she said that was in contrast to liability agreements.  Liability "does not have the same formal review process although our regional offices will consider review of proposed liability set-aside amounts depending on their particular work load and whether or not they believe significant dollars are at issue." 
  (Transcript, pg. 24).

       In addition, CMS also has released several Alerts explaining Section 111, which do not indicate any intent to require MSAs for liability claims.  For example:

• "Unless you are a business entity which qualifies as [a required reporting entity (RRE)] for purposes of Section 111, you do not need to initiate any specific actions in connection with Section 111."  (CMS Alert, 2/23/09).(3)
   
• "The new Section 111 requirements do not change or eliminate any existing obligations under the MSP statutory provisions or regulations."  (CMS Alert, 2/23/09).

       Moreover, the Congressional Research Service (CRS) provided Congress with an "objective and non-partisan analysis" analysis of the MMSEA.  As there was no legislative history regarding the bill, the CRS research report is the most reliable analysis of the MMSEA, including the Section 111 reporting requirements.

       CRS' analysis of the Section 111 reiterates that it is a reporting requirement, and makes no mention of the need for set-asides in liability cases.  The Section 111 analysis states, in part:

This provision requires an insurer or third-party administrator for a group health plan (and in the case of a group health plan that is self-insured and self-administered, a plan administrator or fiduciary) to (1) secure from the plan sponsor and participants information required by the Secretary for the purpose of identifying situations where the group health plan is or has been a primary plan to Medicare, and (2) submit information specified by the Secretary.  If an insurer or third-party administrator for a group health plan fails to comply, then a $1,000 per day civil monetary penalty will be imposed for each individual for which information should have been submitted.(4)

If CRS believed that the legislative language implies any Congressional endorsement of liability set-asides, it would have been included in this analysis.

       We hope this information will be useful in your settlement negotiations. 

 

 

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Segeorgialaw.com I noted earlier had its debut this week.

From that site:

 

The lawyers will work for folks who live in Southeast Georgia – Brunswick,  Nahunta, Waycross, Homerville, Kingsland,  St. Mary’s, and our counties – Camden, Glynn, Charlton, Brantley. People in those areas don’t have to pick up the phone and talk with a North Florida-based lawyer to get justice.

 

The Docket: I've filed three cases in Glynn County involving auto accidents this month. Our office is located at 1728 Newcastle Street in Brunswick, and we're there this Friday.

 

 

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My firm has opened an office in Brunswick, Georgia handling automobile accidents, pharmacy litigation, and other injury cases.

I've been litigating in Southeast Georgia for some time now, and given how much time I spend there, it was an easy decision. 

My office helps those in Glynn County, Brantley, Camden, and others. Cities like Brunswick, Woodbine, St. Mary's, Waycross, Nahunta are within our lawyer assistance area. 

Here are a few tips on how to handle a claim yourself:

 

Here are some tips that could help maximize your auto insurance claim without litigation.  If you disagree with your insurance company you can use these tips on disputed insurance claims to maximize them.

 

You can reach Mark Zamora:  segeorgialaw@yahoo.com

1. Most of the time your agent may not be able to solve your problem if there is a dispute.  It is best to deal directly with the insuring company.  Get the name and phone number of your insurance companies Claims Department. It's usually an 800 number. Ask for their Consumer Complaint Department or Customer Services.  Most insurance companies have consumer cell who would be more forthcoming in helping you as it is a matter of goodwill and brand building for all good companies.  Talk to them and explain the problem in detail.  Get the specific name of the person with whom you spoke. Make a note of the person you talked with and hold onto that until you've finished with your dispute.  

2. You may follow up your talk with your case by sending a letter or email to the individual whom you spoke with which contains all the documents you have to back up your position.

3. All insurance companies have either an "Appraisal Service" or "Arbitration Service" to help settle differences and/or disputes. Your policy should explain these options.  If you can't find either of these ask your agent to find them for you!

4. If you've followed their rules for resolving your dispute, and you're still not satisfied, your own state's insurance department should be able to help you.  Most countries have an Insurance ombudsman to monitor such grievances.

 

Or, call us at 877-474-6454

 

 

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For good hardworking people, it''s time to sound the alarm about proposed GA legislation:  

 

From the GTLA:

Governor Perdue wants to place the safety of Georgia’s citizens in the hands of a mismanaged federal bureaucracy

Georgia lawmakers introduced SB 101. Senate Bill 101 would grant new protections from product-liability suits to Georgia companies whose products have Food and Drug Administration approval.

In essence SB 101 seeks to rely on the federal Food and Drug Administration (FDA) amidst grave controversy while giving large pharmaceutical companies who harm Georgians a “Get out of Jail Free” card

Governor Perdue suggests that a federal bureaucracy embroiled in heavy controversy, the FDA, should have all the power in deciding the safety of pharmaceuticals and medical devices. SB 101 bars any Georgia citizen from bringing a products liability claim against a pharmaceutical corporation so long as it is headquartered or has 200 employees in Georgia and the product in question, either a drug or a medical device, is FDA approved.

“Vioxx was an FDA approved drug that harmed at least 139,000 people. If there were to be a drug or medical device made here in Georgia that injured or killed people like Vioxx did, Georgia residents would have absolutely no recourse. A person in Phoenix City, Alabama could pursue justice; a person in Columbus could not,” said Fred Orr, President of the Georgia Trial Lawyers Association. “The Governor believes SB 101 will bring corporations to Georgia. But I don’t think we want the kind of business this legislation would attract as this bill says, “Move to Georgia! You can harm or kill our citizens and you will not be held accountable!”

The Governor stated early in the session that FDA approval “should mean something” and that it should protect corporations from lawsuits.

“The FDA can’t protect us from peanut butter. How can we possibly rely on the FDA to protect us from dangerous drugs and medical devices?” said Orr. “If a pharmaceutical corporation manufactures a drug or medical device that seriously harms or kills an innocent person, that corporation should not, under any circumstance, be shielded from accountability. The Governor has simply gone too far with this proposal.”

On February 2, 2009 President Obama had harsh words for the FDA and he urged Congress to conduct a complete review of the FDA after the agency failed to protect the public from contaminated peanut butter. At this time the contaminated peanut butter has killed 8 people and sickened over 500 people.

In addition to the agency’s failure to protect the public from peanut butter, as recently as the last month, the FDA has been at the center of three other nationally publicized controversies concerning alleged corruption, mismanagement, and claims of serious financial conflicts of interest. First the federal Government Accountability Office (GAO) released a report revealing that the FDA has failed to comply with a congressional mandate set nineteen years ago that requires manufacturers of medical devices to provide proof of rigorous testing and safety analysis to the FDA for all Tier 3 medical devices (classified as those devices that are implanted or that a person relies on for life) prior to approval.

Second, a group of FDA scientists went public with their allegations of corruption, mismanagement and coercion within the FDA. The scientists stated that the scientific review process for medical devices “has been corrupted and distorted by current FDA managers, thereby placing the American people at risk.” They allege that managers at the FDA lacked scientific knowledge and clinical expertise regarding medical devices and that they have ignored the experts and scientists within the FDA. The authors stated that they had been ordered to modify their findings and evaluations of medical devices—allowing for the approval of products that may not be safe.

And third, the Inspector General of the Department of Health and Human Services (HHS) issued a report uncovering a troublesome conflict of interest inherent in the FDA approval system. The FDA failed to collect information on financial ties between those that perform clinical tests and the pharmaceutical companies that manufacture the product being tested in an alarming 42% of the cases. HHS claims that such financial ties may compromise the safety of the people in the clinical trials and the authenticity and integrity of the final research data.

“The scientists working at the FDA think that Americans are in danger. Other governmental entities report that the FDA is inept at keeping the American public safe. Yet Governor Perdue inexplicably thinks we should trust a corrupt federal bureaucracy to keep Georgians safe,” said Andy Childers, an Atlanta attorney.

National leaders in medicine don’t think that FDA approval is enough to keep people safe either. In a friend-of-the-court brief filed in association with the case of Wyeth v Levine, multiple editors of the New England Journal of Medicine stated, “The FDA alone simply lacks the ability to serve as the sole guarantor of drug safety." The doctors went on to say that without civil lawsuits and the discovery they produce, "the FDA would be stripped of an essential source of information that the agency has consistently relied on when making its regulatory decisions, and the American public would be deprived of a vital deterrent against pharmaceutical company misconduct."


NOTE: For more information on the FDA approval process and other Government reports, please contact Rebecca DeHart at GTLA.



The Georgia Trial Lawyers Association
Protecting the Constitutional Promise of Justice for all by
Guaranteeing the Right to Trial by Jury,
Preserving an Independent Judiciary, and
Providing Access to the Courts for all Georgian

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