Prescription Medication Services Enhancement from Carr Allison's Medicare Compliance Group

Carr Allison’s Medicare Compliance Group is excited to announce the selection of Carlisle Medical as the provider of independent Prescription Medication Reviews conducted by licensed pharmacists for Carr Allison’s clients. Carr Allison based its decision on Carlisle Medical’s leadership for more than 30 years in providing pharmacy, DME and case management solutions nationwide.

"The arrangement between Carlisle Medical and Carr Allison is an illustration of cohesive efforts to control the rising costs of healthcare, specifically the cost of prescription drugs," said Donnie R. Carlisle, Founder and CEO of Carlisle Medical. "Like Carr Allison, we are committed to providing unparalleled results for our clients. Prescription Medication Reviews have shown positive results in both patient outcomes and financial effects, saving clients an average of 35 to 50% per review."

Carr Allison anticipates that these savings will contribute to lower Medicare Set-aside and Liability Settlement Allocations, as well as lower reserves and overall settlement values.

The following client services are now available:

Prescription Medication Review by an independent, licensed pharmacist
Retail Pharmacy Network Program
Home Delivery Pharmacy Program
For more information about Carlisle Medical, please visit www.carlislemedical.com. If you have any questions about these new services, please do not hesitate to contact us at mzwilling@carrallison.com.

Court Follows Sixth’s Circuit Decision that Providers May Assert a Private Cause of Action

In Michigan Spine & Brain Surgeons v. State Farm Mutual Automobile Insurance Co., No. 12-CV-11329, 2013 U.S. Dist. LEXIS 17721 (E.D. Mich. Feb. 11, 2013), State Farm denied coverage of medical treatment provided by Michigan Spine on the basis that the treatment was related to preexisting conditions of the individual insured, and unrelated to the accident at issue.  As a result, Medicare paid for those medical expenses.  Michigan Spine filed a claim for recovery against State Farm, asserting that it had a private cause of action for double damages under the Medicare Secondary Payer Act.  In response, State Farm argued that Michigan Spine had no standing to bring a claim under the Medicare Secondary Payer Act because no court had determined that State Farm was liable for the medical services in question.

The Court acknowledged that the underlying issue was addressed by the Sixth Circuit in Bio-Medical Applications of Tennessee., Inc. v. Central States Health & Welfare Fund, 656 F.3d 277 (6th Cir. 2011).  In that case, the Sixth Circuit held that “a healthcare provider need not previously 'demonstrate' a private insurer's responsibility to pay before bringing a lawsuit under the Act's private cause of action.” Mich. Spine & Brain Surgeons, 2013 U.S. Dist. LEXIS 17721, at *15 (citing Bio-Medical Applications of Tenn., Inc., 656 F.3d at 278-79). The district court followed the Sixth’s Circuit decision in Bio-Medical Applications of Tenn., Inc., and accordingly, denied State Farm’s Motion to Dismiss. 

Early v. Carnival Corporation: Liability Case with MSA Issue

In Susan Early v. Carnival Corporation, 2013 U.S. Dist. LEXIS 16711 (decided February 7, 2013), the parties mediated a liability case in November and believed that they had reached a settlement agreement.  Specifically, the parties agreed that the defendant would pay plaintiff an undisclosed sum, that each party would be responsible for its own fees and costs, that plaintiff would execute a release, and that defendant would be responsible for the mediator's fees.  The parties could not agree, however, on the issue of whether an MSA was required, but they did "agree" to submit the issue to the court for resolution.  The mediator believed the case settled and noted this to the court, and the parties then filed their respective arguments that an MSA was (or was not) required.

Upon a review of the issue, the court found that no settlement agreement had been created.  Under Florida law, settlements must "be sufficiently specific and mutually agreeable on every essential term," and an agreement to agree is not enough (Id. at *4).  Ultimately, an agreement to disagree was not enough, either.  The court refused to create an essential settlement term - in this case, whether or not to include an MSA in the settlement - and it refused to issue an advisory opinion.  This case was not one in which the parties had agreed upon an MSA and needed the court's assistance as to the amount of the MSA, nor was it one in which the parties had an agreement but, after the fact, disagreed as to whether the settlement included an MSA.  Thus, no agreement existed and the court declined to assist the parties in creating one.   

It is important to note that, in many ways, this is a decision about procedure.  The court notes that, in this case, the MSA (or lack thereof) is an essential term of an enforceable settlement agreement.  The court's refusal to create an essential settlement term does not mean that the court will never assist the parties on this issue, however.  It is simply premature to do so at this stage of the proceedings.  If the case's remaining issue in dispute - whether or not Medicare's future interests need to be protected - cannot be resolved by agreement between the parties, it can be resolved by the court on March 25, 2013, when the case goes to trial.

Second Chance! SMART Act Webinar

Did you miss the January webinar?  Here's your second chance to learn more about the SMART Act.

 

Join us for a Webinar on February 19

 

 

Space is limited.

Reserve your Webinar Seat Now at:
https://www4.gotomeeting.com/register/267758087

 

 

Getting Smart About the SMART Act

• Do you have questions about the SMART Act?
• What changes are ahead?
• How will it impact the way liability and workers' compensation claims are handled?
• When will the new provisions take effect?

Join Melisa Zwilling, Esq., Chair of the Medicare Compliance Group at the law firm of Carr Allison, as she addresses each of these questions and more during a free client webinar: Tuesday February 19, 2013 at 11:00 Central Standard Time.  During the presentation, you will have the opportunity to submit questions and receive the answers you need.  As a national leader in Medicare Compliance issues for over twelve years, Melisa and her team have the experience and knowledge necessary to lead you successfully forward.