NAMSAP Quarterly Newsletter
Volume 8, Number 2                                                                                                May 2016
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NAMSAP Proposes Evidence-Based Limits on Opioids
For Workers' Compensation Medicare Set-Aside Arrangements
Press Release
Elmhurst, IL
March 23, 2016:  

National attention is finally being paid to the opioid epidemic in the United States, as we experience the catastrophic impact of the robust marketing of those drugs on Americans for treating chronic, non-malignant diagnoses such as back pain and arthritis since the 1990's. The National Alliance of Medicare Set-Aside Professionals (NAMSAP) is leading the charge on limiting opioid usage by requesting that the Centers for Medicare and Medicaid Services (CMS) cap costs earmarked for future opioid expenditures, thereby seeking to reduce ongoing usage of these dangerous medications...

Click Here to read the press release.
President's Letter
By: Gary Patureau, CWCP, CMSP
Executive Director/COO, Louisiana Association of Self-Insured Employers (LASIE)

NAMSAP Members:
I would like to thank all that have renewed their membership for 2016 and would like to encourage those that have not yet renewed for 2016 to do so asap.  For all those that are reading the NAMSAP Advisor for the first time and are not a member, I would like to say welcome and urge you to join NAMSAP.  
The Board of Directors, Advisory Council and committee members are working to rebrand and strategically revitalize NAMSAP as an organization.  We have been very active this year in all areas.  One of our main goals is to get our members to join us by rolling up their shirtsleeves.  We are encouraging our members to join individual committees.  

Click Here to read the entire article.
Medicaid Issue Spotting

Robert L Sagrillo, JD, LLM
      President and Chief Legal Officer, 

As Medicare Secondary Payer (MSP) consultants, we tend to be contacted by clients about other public benefit issues that arise during the claim resolution process. Lately, it seems that Medicaid is the hot topic. Concerns include reporting obligations and lien resolution. This article provides high-level background on both of these concerns to enable the parties to spot issues in a given claim. Of course, once the issues are spotted, a resource will need to be identified to aid in resolution...

Click Here to read the entire article.
STARS Opioids

By:  Steven J. Miller, M.S.Pham. D. Ph., R. Ph.
       President, Clinical Services

The Medicare STARS ratings system began in 2007 as a way for CMS and Medicare beneficiaries to assess Medicare Advantage (MA) health plans. The introduction of a 5-star quality rating system by the Affordable Care Act (ACA) has brought some big changes to the MA market, including market consolidation and movement towards higher quality offerings in the marketplace by the remaining plans...

Click Here to read the entire article.
New MSP False Claims Act Litigation:
Did Progressive Ignore the Forest for the Trees?

Heather  Schwartz Sanderson, Esq., MSCC, CHPE, CLMP, CMSP 
      Chief Legal Officer

The False Claims Act's (FCA) purpose is to deter fraud upon the U.S. government, and whistleblowers are incentivized to bring such actions due to the potential to recover triple damages against the fraudulent entity. With regard to Medicare Secondary Payer (MSP) FCA litigation, we have really only seen two whistleblowers try to bring MSP FCA actions up until now, United States of America ex. rel. Dr. Kent Takemoto v. ACE et al. and United States, ex. rel. J. Michael Hayes v. Allstate Insurance Company, et al. As of just last month, January 2016, both Takemoto and Hayes' actions were dismissed in the Western District of New York for failure to plead specificity in their claims. Only the United States is able to re-assert these actions, which it is unlikely to do, since it didn't intervene in the suit initially...

Click Here to read the entire article.
Committee News

(Click the committee title to read report)

NAMSAP Annual Meeting
September 14 - 16, 2016


Welcome New Partner Professional Members



The NAMSAP Communications Committee would like to encourage you to submit an industry-related article for our upcoming newsletter. We are accepting submissions in the following categories: Legal, Legislative, and Medical. If you are interested in contributing to one of these categories, or have an idea for a new category, please contact Rita Wilson, Communications Committee Chair. She can be reached by email at


Click here for past newsletter editions!

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