LCA Hits on “Warning Shot” in MSA Case, Nitty Gritty of Medical Marijuana

The Louisiana Claims Association held its 2017 conference at the Hilton Capitol Center in Baton Rouge June 7th-9th. The event featured an entire track of lectures geared toward workers’ compensation professionals and the meeting rooms filled up fast, given that new licensing requirements including continuing education for workers’ comp adjusters are now in effect across the state.

The event, now in its 23rd year, highlighted speakers from other parts of the country. Jose Ortiz of Absolute Data Processing on medical marijuana and Mark Popolizio of ISO Claims Partners on MSAs were two out-of-state standouts.

 

Ortiz: Marijuana matters for all workplaces, treatments are expanding fast

 

Jose Ortiz President of Absolute Data Processing Inc. kicked off the second afternoon of material by hammering down on the fact that “marijuana is not what it used to be.” Ortiz works in several states where medical marijuana and “green cross” dispensaries are commonplace, including in the state he now calls home, Colorado. He argued that money is the primary factor behind legalization efforts because “the revenue is hard to ignore.”

On the treatment side, Ortiz emphasized the difference between CBD and THC, in hemp and marijuana plants, respectively. CBD, which does not have a psychotropic effect, has been found to be effective for a wide range of conditions. However, even in cases where marijuana is consumed and produces a high from THC, Ortiz asked: “What’s the difference really between that and being high on oxycodone?”

When restrictions are put in place, testing then becomes an issue. Ortiz explained that occasional and chronic users have different concentrations in their blood even when the effect of the drug has worn off. “You can make it a drug-free workplace if you want, but does that apply to all drugs?” Ortiz asked. “Can we really say, legal or illegal, that you can’t have medical marijuana but you can have oxycodone for the same injury? Compensability is the only difference for workers’ comp payers right now but that’s going away.”

Ortiz explained further that his company, as a pharmacy benefit manager, is taking a very close look at CBD’s treatment potential down the road, especially because it can be derived from legal hemp plants and is not psychotropic. “There are something like 92 different versions of CBD. On their own and in combination these have shown effectiveness for cancer, diabetes, weight loss, smoking cessation, and tons of other things,” he said.

Pain management with CBD in particular is one area where Ortiz sees effectiveness and usefulness for workers’ comp. “If there’s a treatment that doesn’t have an addictive effect and doesn’t have an effect on your ability to work, as a substitute for the problems we see with opioids, that could prove beneficial,” he said. “The problem is, some doctors look at this as a moral issue. Some doctors will say they see problems with medical marijuana in clinical practice but can’t point to any evidence that backs them up, especially when compared to opioids. They just don’t think that marijuana should be legal.”

 

Popolizio on CIGA v. Price and its importance to the industry

 

Miami-based VP of MSP Compliance and Policy for ISO Claims Partners Mark Popolizio focused his presentation on practical concerns regarding closing claims and complications at the Centers for Medicare and Medicaid Services (CMS).

In particular, on the conditional payment front, Popolizio pointed out a new ruling in a California case from last month, CIGA v. Price, which expanded limits on Medicare’s conditional payment rights. In the case, CIGA, a guaranty association similar to LIGA in Louisiana, challenged a CMS billing practice seeking full reimbursement of a medical provider’s single charge, even if part of those charges weren’t part of the workers’ compensation plan.

“CIGA came back three times trying to fight these conditional payments,” Popolizio said. “The case where they won involved fighting a billing practice where a medical provider submits one single charge to Medicare and it’s made up of multiple codes. If one of these charges is related to the workers’ compensation claim, Medicare would go ahead and seek reimbursement on the full charge.” CIGA argued that this is improper and the court agreed.

According to Popolizio, the case centered around the fact that CMS’s own manual seemed to conflict with the billing practice. “The court agreed that CIGA could only be liable for what they were liable for under state law,” he explained. After the decision came out, industry and others asked for clarification, which the court then provided. Popolizio broke down that clarification into two parts:

 

  • The disputed reimbursement demands were set aside and vacated, effectively removing CMS’s claim to collect on the non-comp-related charges.
  • The court issued a declaratory order finding the practice unlawful. Popolizio called this a “warning shot” to Medicare stopping just short of a permanent injunction, adding that “CIGA isn’t letting this go” and has a trial on the permanent injunction in September.

 

Popolizio told attendees that he is optimistic about the future of cases like this siding with payers.

 

After each day of meetings, attendees were treated to social events. At the Old State Capitol Building, a cooking demonstration offered appetizers and fun in line with the conference theme of “What’s Cooking?” On Thursday night, a party at the 1913 Club in downtown Baton Rouge gave participants a chance to let loose and celebrate another year of LCA. Rosters indicate that close to 200 industry pros attended this year’s event. The next conference is scheduled for June 6th-8th, 2018, at the Hilton Riverside in New Orleans.

Louisiana Comp Blog will address MSAs and Medicare’s recovery rights at the next “Comp in Focus” luncheon on June 28th at the Ace Hotel New Orleans. Local attorney Thomas Ruli, of Juge Napolitano, will speak along with Kip Daniels of NuQuest. Registration is available here.

 

 

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