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Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007
6/7/2011
 
On July 13, 2011 at PHTS in Columbia, and via webinar for those unable to attend in person, PHTS will present an educational program for PHLIP members, on Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007.

CMS has undertaken a comprehensive effort to collect money owed to Medicare for the payment of expenses that should have been paid by another party first instead of Medicare. Attorneys, claimants, employers, insurers, providers, and others have significant responsibilities and obligations under the Medicare Secondary Payer Act (MSPA). Through the Medicare, Medicaid and State Child Health Insurance Program Extension Act of 2007 (MMSEA), Congress has made significant amendments to the MSPA to allow Medicare to more easily identify situations in which a primary payer exists so it can avoid making conditional payments or more easily recover such payments if made. The law imposes an enormous obligation on judgment, award, or other payment regardless of whether or not there is a determination or admission of liability. The law applies to “liability insurance (including self-insurance), no fault insurance, and workers’ compensation laws and plans. Failure to report primary payer situations as required may result in a penalty of $1,000.00 per day, per claim.”

Upon completion of this seminar, participants should be familiar with:

  • The Difference Between Liens, Medicare Set-Asides, and Section 111 Reporting

  • Medicare Secondary Payer Act (MSPA) enacted in 1980

  • Section 111 Mandatory Insurer Reporting Requirements

  • Write-Offs

  • Medicare Set-asides (in appropriate cases)



The program, which will run from 10:00 a.m. to noon, with lunch following, will be led by Bennett L. Pugh, Esq. of Carr, Allison, Pugh, Howard, Oliver & Sisson, and will be of most interest to CEOs, CFOs, risk managers and chief risk officers, compliance officers, billing office professionals, and both in-house and external legal counsel.

Mr. Pugh is a frequent speaker on workers’ compensation law and Medicare Set-asides, and is a founding partner in Carr Allison, whose attorneys have extensive experience in representing clients across the United State in cases in which Medicare has an interest. Mr. Pugh earned his B.S. from Samford University and his JD from the Cumberland School of Law. He has been named to the Top Lawyers by Corporate Counsel and Best Lawyers in America, and is a member of the Alabama State Bar Association, the Defense Research Institute, the USLAW Network, and the National Workers’ Compensation Defense Network.

There is no registration fee for this PHLIP member-only program. For more information, please contact Larry W. Gray, AIC, executive vice president, claims & risk management at PHTS, at lgray@phts.com. To register, please visit our website at www.phts.com or contact Camillia Y. Austin, AIM, director of education & chief diversity officer at PHTS, at caustin@phts.com.