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June 09, 2005 9:49 PM
Workers' Compensation News - June 10, 2005, Volume 3 Issue 307

CMS TO ISSUE NEW MEDICARE SECONDARY PAYER GUIDANCE
Under mounting pressure from many organized groups, CMS (The Center for Medicaid and Medicare Services) has indicated that it will shortly release a new set of "Questions and Answers" in order to, yet again, redefine its procedures. 

Since 1980 Medicare has been entitled to be reimbursed for expenditures that it has made conditionally even though Workers' Compensation programs could be primarily responsible for the medical expense. CMS has sought reimbursement for conditional payments made and for future medical care that could be the responsibility of the workers compensation program should a claim be fully and favorably adjudicated for the injured worker.

Even though CMS has ramped up its program by expanding its staff and has initiated "data match" systems with a growing list of major industrial States, CMS continues to delay the settlement of workers' compensation claims for months at end causing a major disruption in the remedial workers' compensation programs throughout the country. The AMA and several groups have endorsed proposed Federal legislative changes. 

Theoretically, "data matching" between the States and CMS would expedite identification of injured workers who may potentially receive both benefits, ie. workers' compensation and Medicare. Such identification would permit computer recognition and availability of conflicting medical expenditure information. Medicare is the largest payer of medical benefits in the country and accounts for one-third of all payment. While Social Security is ailing financially critics warn that its accounting may not be accurate. 

Unconfirmed rumors abound that CMA will announce a requirement that only workers' compensation settlement greater than $15,000will be required to be submitted to CMS for review and that for amounts over $15,000 CMS will require that 15% of the settlement be set aside in an agreement for future medical care. It is anticipated that within the next 60 days the proposal will be issued in the form of a series of "Questions and Answers."

For these stories and others visit our web site http://www.gelmans.com

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FOX AIRES INTERVIEW BLAMING WORKERS COMPENSATION FOR THE ASBESTOS BANKRUPTCIES
"...lousy workers comp laws..." states Frank Clemente, Public Citizen Congress Watch
Fox News On Asbestos Comp: Old Politics Creates New Legal License to Kill
http://spewingforth.blogspot.com/2005/06/fox-news-on-asbestos-comp-old-politics.html

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ILLINOIS
Governor Blagojevich congratulates General Assembly for passing unprecedented reforms to the Workers’ Compensation system 
Bill provides fundamental change for the first time in almost 20 years.
· Implementing a medical fee schedule. 
· Worker benefits to increase substantially. 
· Establishes a fraud unit. 
· Creates a third panel to the Workers’ Compensation Commission. 
http://www.illinois.gov/PressReleases/ShowPressRelease.cfm?SubjectID=1&RecNum=3997

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AIG
AIG Hid Rate Scam, Suit Says: Insurer Allegedly Cheated State out of Millions of Dollars
Insurance giant AIG Inc. evaded answering questionnaires from California's Department of Insurance for years so it could cheat the state out of millions of dollars in taxes and fees, New York Attorney General Eliot Spitzer has alleged in a lawsuit.
http://www.sacbee.com/content/news/crime/story/12994008p-13840670c.html

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NJ ATTORNEY GENERAL
NJ Attorney General Asbestos Suit Asks for $1.6B
3 Decades of Illegal Behavior Cited!
State Attorney General Peter Harvey is seeking up to $1.6 billion in penalties from construction products maker W.R. Grace & Co. and two company executives for allegedly violating state environmental laws at a plant the company operated in Hamilton for more than three decades. 
http://www.nj.com/search/index.ssf?/base/news-0/1117699877210920.xml?times?nxta&coll=5

Editior - Trenton Times
Don't Stop Now!
The State of New Jersey sued W.R. Grace & Co. and two of its officials yesterday for allegedly providing false information to state environmental regulators when the company closed its fireproofing and insulation plant in Hamilton in 1995. The action, taken one day before the statute of limitations expired, is a step in the right direction. 
http://www.nj.com/search/index.ssf?/base/news-0/1117699793210920.xml?times?nex&coll=5

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ASBESTOS
Loose Coalition of Advocacy Groups Surfacing in Opposition to Asbestos Bill
A day after the Senate Judiciary Committee approved a bill (S. 852) that would create a $140 billion trust fund for workers who were exposed to asbestos, a loose coalition of consumer, environmental, civil rights, and "victims" groups May 27 decried the measure as unfair to individuals who have asbestos-related illnesses. 
Bureau of National Affairs

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Calendar:
25th ANNUAL NATIONAL WORKERS' COMPENSATION AND OCCUPATIONAL MEDICINE CONFERENCE JULY 2005
July 19-21, 2005, Hyannis, Cape Cod, Massachusetts
-Managing Workers' Compensation Claims While Navigating the Treacherous Waters of the Medicare Secondary Payer Act
-Trial Demonstration: The Contested Hearing Loss Case
http://www.seak.com/semjul05WC.htm

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