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  1. #1
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    Default Medical Set Aside

    How is a number for medical set aside made? I understand it is an amount strictly for medical,but how is the amount decided?

  2. #2
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    Default Re: Medical Set Aside

    Their docs review your past medical and present status, then make a wild guess, usually as high as humanly possible and in their favor.
    If they had their way, they'd make you setaside your entire settlement and everything you own.
    What the joke about this scam is, if you where a drug dealer, shot in a drive by, you'd be eligible for everything without setting aside a dollar, even if you where a millionaire.
    It's basically a penalty against worker comp claimants, we're supposedly richer than anybody and recieved our money by cheating the system. (bums if you will)
    Tony
    Last edited by tony; 01-28-2010 at 04:37 AM.
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  3. #3
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    Default Re: Medical Set Aside

    Why is there a perception you are 'setting aside' a portion of your settlement ?
    The MSA money does NOT come from the indemnity award/settlement of a WC claim.

    If you are in need of additonal/future medical treatment, don't close out the medical benefits in the claim.
    When you do, you are agreeing to accept liability for your injury. The medical treatment is the ER/IC liability, not the IW. Medicare wants a portion of the future medical money you receive...that you agree to use for treatment to the injured body part, put in a seperate account to be SURE you have the money to use for treatment.
    YOU (or the carrier, or MSA vendor) submit a proposal to CMS for review... the dollar amount is based an a estimation of your potential medical needs.
    If you have significant treatment needs...the numbers will be higher.

    MSA"s are a double edged sword... the higher the dollars, the more difficult to settle the medical ...the longer before Medicare will begin to pay...and you will begin to pay out of pocket the copays/deductibles.
    Lower the MSA numbers... the sooner Medicare pays...and the sooner you see those out of pocket costs begin.

    It's all about liability WHO pays for treatment to your injury.

    IW's may think they get out of the 'system' be selling the medical benefits in a comp claim... with a WCMSA, in most situations you are simply trading one system for another. And YOU/IW takes over administration of the claim.
    What the joke about this scam is, if you where a drug dealer, shot in a drive by, you'd be eligible for everything without setting aside a dollar, even if you where a millionaire.
    That may be true. But nor would you be getting a check for payment of that medical treatmetn either.
    IW's get a check for future medical care... Why should we/taxpayers/Medicare pay for treatment where the IW has already been compensated ? THAT is double dipping.
    Unless something is done, it will be come increasingly difficult to settle your WC case...
    Don't. Don't close out the FMC. Either take the indemnity payments over time...the way it's set up legally... or petition the court for a commutation, and take a reduced dollar. (some states ie NY permit lump sum w/o reduction)
    Their docs review your past medical and present status, then make a wild guess, usually as high as humanly possible and in their favor.
    How would a high dollar value to FMC be in their favor?
    The carrier wants to close the file... the higher value of FMC the less 'favor' to them in cashing out the FMC. The IW accepts liability for FMC when cashing out the FMC in a claim... the lower the dollar figures the more likely the carrier is to jump at the opportunity to close out the file.
    How is a number for medical set aside made? I understand it is an amount strictly for medical,but how is the amount decided?
    IT's based on your FMC/future medical care needs. Depending on your condition, and Medicare eligiblity, a life care plan is done for you... and estimates of the potential cost of treatment to your injury, as well as any other services Medicare would normally be responsible for.
    In most but not all claims... where the IW is receiving SSDI, or normal retirement benefits, the eligiblity is due to catastrophic injury, and a higher need for treatment.
    As the ER/IC is liable for treatment to the injury, CMS/Medicare wants a portion of the FMC money you receive setaside in a seperate account to be sure Medicare interests are protected... to be sure you don't go off and spend the FMC money on a 'hog' or house, and shift liability to Medicare for your treatment.

    In a FMC/future medical award or settlement, there should be allocations for the MSA as well as money for services/treatment Medicare is not normally responsible. Not all treatment is medically necessary under Medicare approved charges. For those services there should be money not accountable to Medicare and you can spend that for any services you wish. Including a 'hog' if you like.

    In the past, ER/IC's have gotten away with funding a MSA and NO allocation for non Medicare treatment costs. IW's were left to pay out of pocket for those items... and IC's walked happy in their tracks of ill gotten gains.
    With the passage of the new laws, most of this is no longer the case.
    So many AA's, IC's and IW's in the past have successfully shifted liability to Medicare, Congress changed that with the MSPA/Medicare Secondary Payor Act changes and CMS is going after claims that cash out the FMC. Finally.

  4. #4
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    Default Re: Medical Set Aside

    BvIA
    Why is there a perception you are 'setting aside' a portion of your settlement ?
    Because it is taken directly from the total amount of the the settelment, of which the attorney basis his fees on.. your indemnity.
    I haven't see where the setaside amount is free from attorney fees or worded as "future medical"



    The MSA money does NOT come from the indemnity award/settlement of a WC claim.
    The attorney recieves his fees based on a percentage of the indeminity, which included the setaside.
    That's why it is considered "your money".
    You have to report the entire amount of the settlement (which includes the setaside) as income when applying for food stamps or public assistance, it's not seperate.
    If it was a part of future medical that the IC had to pay, then why is the claimants attorney negotiating the setaside to make it as low as possible?
    You sure don't see the IC negotiating the setaside.

    How would a high dollar value to FMC be in their favor?
    Oh please, you're not that stupid.
    The higher the setaside, the less they pay, come on....let's get real.

    In the past, ER/IC's have gotten away with funding a MSA and NO allocation for non Medicare treatment costs. IW's were left to pay out of pocket for those items
    Non Medicare treatment costs can't be paid out of a setaside, IW's still have to pay out of pocket for those costs, what are you talking about?

    The whole thing is a scam period, you me and God knows it.

    If medicare feels they have money coming, let em get it from the insurance.
    Let the IC set up a setaside account and manage it, they are the ones responsible for medical, not the claimant.
    It's exactly as you said "IC's walk happy in their tracks of ill gotten gains."
    You can dam well believe, if the IC had an interest in the setasides, they would be involved in the negotiations and there would be reform tomorrow.

    Tony
    Last edited by tony; 01-28-2010 at 07:37 AM.
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  5. #5
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    Default Re: Medical Set Aside

    Because it is taken directly from the total amount of the the settelment, of which the attorney basis his fees on.. your indemnity.
    I haven't see where the setaside amount is free from attorney fees or worded as "future medical"
    Indemnity is pre deterimined as a number of weeks payments based on the PPD rating.
    In a C&R settlement the atty fees are based on the full amount. And, no the AA fees can not be taken from the MSA proceeds. CMS/Medicare does not permit any atty fees from a MSA.

    Settlements should include allocations for indemnity, and ''future medical''. If there were not need for additional medical treatment, there wouldn't be an FMC included in a settlement. Nor would there be need to pay lump sum to close medical in a comp claim.
    The attorney recieves his fees based on a percentage of the indeminity, which included the setaside.
    That's why it is considered "your money".
    The AA is negotiating a ''lump sum'' cash payment to close the claim. In some cases that is indemnity only. In others that includes payment for future medical needs. FMC is not part of a indemnity settlement.
    The other maybe more important reason for adequate allocations is the issue of apportionment to cause. Where/If there is subsequent injury, and resulting PD, when the rating issues for the new injury, the prior % is deducted. In some cases, it's the dollar amount that reduces the award in the next claim.
    Indemnity payments would be considered, not the money for FMC.
    You have to report the entire amount of the settlement (which includes the setaside) as income when applying for food stamps or public assistance, it's not seperate.
    That has nothing to do with a WCMSA.

    If it was a part of future medical that the IC had to pay, then why is the claimants attorney negotiating the setaside to make it as low as possible?
    You sure don't see the IC negotiating the setaside.
    No one 'negotiates' a MSA. CMS reviews a proposal submitted by one of the parties to protect Medicare interests.
    AA's who try for lower MSA dollars are looking out for the IW's best interests, in reducing the fees due on the full amount of the C&R.
    ALL cash settlements that close out the claim are C&R's. Whether they are for indemnity only, or include compensation for future medical.
    How would a high dollar value to FMC be in their favor?

    Oh please, you're not that stupid.
    The higher the setaside, the less they pay, come on....let's get real.
    C'mon Tony... that can't even sound right to you. IF there is a high dollar value to a MSA, the carrier would pay the full amount if they agree to the C&R. They aren't going to pay less because a MSA has a high value.
    The carrier is liable for the medical in a claim. Period. IF the parties agree to close the claim, including FMC, whether it includes a MSA or not, the dollar value of a FMC is the same one way or the other.

    CMS/Medicare wants a portion of the FMC award/settlement in a seperate account. That is all a MSA is. A seperate, ''setaside'' arrangement.

    Non Medicare treatment costs can't be paid out of a setaside, IW's still have to pay out of pocket for those costs, what are you talking about?
    FMC settlement allocations should be for MSA's and non/Medicare services. THAT is the money IW's use as 'out of pocket' money to pay for non Medicare services. Those dollars are not accountable to Medicare as WCMSA money is.

    If medicare feels they have money coming, let em get it from the insurance.
    Let the IC set up a setaside account and manage it, they are the ones responsible for medical, not the claimant.
    Medicare does NOT have any money coming to them. NO money goes to Medicare. EVER.
    IW's 'sell' the FMC in a comp claim for a negotiated cash payment. IF they are Medicare eligible, CMS wants to know how much money that is, and HOW much is potentially going to be a Medicare responsibility...IF you could shift that liability to Medicare. As such, CMS wants a proposal on the FMC and what portion you intend to ''setaside'' to protect their interests.

    The IC's dont need a WCMSA. They have a 'setaside' account...it's called ''reserves'' and are required by state law. If the IW doesn't ''sell'' the medical benefits in the claim... the carrier will continue to use their ''setaside'' to pay the bills.

    Medicare wants the money setaside to be sure the IWs don't spend that FMC money on something else and then have Medicare pay the bills. There is no scam... a WCMSA protects you and me and all the other IW's who have not sold their medical benefits.
    Personal Injury claims carry the same responsibility.
    If you don't want to deal with future medical treatment issues... don't close out the benefits in the claim.

    I haven't see where the setaside amount is free from attorney fees or worded as "future medical"
    I have to edit that statement...
    I haven't see where the setaside amount worded as "future medical"
    What is the dollar award/settlement described as in excess of 'indemnity'. Indemnity is pre determined as I stated above. A given number of weeks for a scheduled injury or whole person impairment.
    What other money would an IW be due in a settlement as compensation for suffering the injury? If you settle for 50K, and only 25K is scheduled for indemnity... what is the 25K for ?

  6. #6
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    Default Re: Medical Set Aside

    Bottom line, the setaside is negotiated by the claimants attorney, not the IC, you know why?
    Because the IC has no interest, they could care if it where a million.
    You're right as to the fact that Medicare doesn't negotiate, but attorneys do try.

    We've had cases right here in this forum where the setaside was more or equal to the settelement, so much for it's seperate from the indeminity.

    Don't tell me the setaside isn't included in the total settlement and a part of the attorney fees, I know first hand it is and have seen it time and time again.
    No, the attorney fees aren't taken from the MESA they are based on the total settlement which includes the MSA.
    In the ideal world what you're saying would be nice, but I haven't seen it.
    Like everything, the setasides are misused by the IC to dump their responsibilities on the injured worker.
    It's all a spin job and a play with words, bottom line the setaside is deducted from your total settlement, of which your attorney fees are based.
    If anyone doesn't believe me, see what's left to your settlement after the MSA and attorney fees.
    It's getting to a point where it's not worth settling, you'd be better off with lifetime payments and medical.

    Like I said, why doesn't medicare make the IC set the money aside, then they would be sure the injured worker doesn't buy food or pay rent with it.
    Why isn't a drug dealer who was shot or an ex con released from prison required to look after medicares interest?
    I've seen both right here in my town, milk medicare for everything they could get, never paid a dime.
    The whole deal is a scam and always will be in my book.
    Tony
    Last edited by tony; 01-28-2010 at 09:06 AM.
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  7. #7
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    Default Re: Medical Set Aside

    Bottom line, the setaside is negotiated by the claimants attorney, not the IC, you know why?
    Because the IC has no interest, they could care if it where a million.
    Of course the IC's care about the dollars in FMC... if it's extensive, they aren't going to be able to close the file. Too much money, and they're better off taking the bet IW's will die before they spend that much money in medical. Lower dolllar values and they jump at a C&R. It's there way to shift to Medicare. They have in the past screwed IW's by not providing the non-Medicare dollars.

    In a C&R, which would be the only time a WCMSA is necessary, the AA fees are based on the full amount of the settlement..that is true.

    Whether the settlement is indemnity only, or includes money for FMC, the bottom line is the same. It's a C&R, lump sum payment. Whether the allocations are MSA and Non-Medicare services...the end result is the same. It's the IWs money no matter how you look at it... CMS requirement is that a portion of the FMC award money is 'setaside'. It's still the IW's money to pay for that service/treatment required for the injury.
    We've had cases right here in this forum where the setaside was more or equal to the settelement, so much for it's seperate from the indeminity.
    Indemnity is indemnity...
    Future medical care money is FMC money. They are totally seperate. If there is no need for FMC, there would be no money for FMC, and the settlement would be limited to indemnity money only. The AA fees would still be based on that lump sum payment.
    Don't tell me the setaside isn't included in the total settlement and a part of the attorney fees, I know first hand it is and have seen it time and time again.
    Of course AA fees are to be paid on the MSA money... that is part of the lump sum.
    Just because the money is called MSA or FMC, lump sum cash payments are still just that. It's the allocations, where the money is directed, and how it's split up in the document language.
    It's all a spin job and a play with words, bottom line the setaside is deducted from your total settlement, of which your attorney fees are based.
    There is no money deducted from any settlement.
    Whether there is a MSA required or not... there can still be the exact same dollar amount in a settlement that includes FMC. The same money goes to the IW... regardless of where the deposit is made. CMS just wants to know that part of the lump sum is 'setaside' as a guarantee. IW's still use the money for FMC. But, only for what Medicare would normally be paying to a regularly Medicare eligible beneficiary. A formal WCMSA is only necessary because the IW is Medicare eligible. (Or, in some cases where the IW is Medicare eligible through normal retirement.)
    Like I said, why doesn't medicare make the IC set the money aside, then they would be sure the injured worker doesn't buy food or pay rent with it.
    As I said... carriers/IC are required to 'setaside' money to cover the exposure in all claims... its' called 'reserves'.
    Why isn't a drug dealer who was shot or an ex con released from prison required to look after medicares interest?
    Everyone, you, me and IW's and yes Dr's and drug dealers are supposed to protect MEdicare interests... its' out tax dollars paying those medical bills.

    But... In a PI claim, or WC claim, where an IW is receiving money up front to cover their future medical needs, that money is supposed to be used ONLY for that treatment. Drug dealers who are shot don't have money from any settlement, Like IW's do. Medicare wants to be sure there is no double dipping and shifting liability.
    The whole deal is a scam and always will be in my book.
    Sorry... I don't see any scam here...
    Why should an IW be paid money for their treatment needs, and spend it elsewhere then ask Medicare to pay for treatment. You would not agree to that and neither do I or CMS.
    It's getting to a point where it's not worth settling, you'd be better off with lifetime payments and medical.
    It never has been in the IWs best interests where future medical is anticipated to be extremely costly to close out or sell their FMC benefits. As long as the ER/IC is liable, they should be paying the bills. That is as long as the claim is open or medical is necessary.

  8. #8
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    Default Re: Medical Set Aside

    http://www.cms.hhs.gov/WorkersCompAg...submission.pdf

    Quote Quoting BvIA View Post
    Of course the IC's care about the dollars in FMC... if it's extensive, they aren't going to be able to close the file. Too much money, and they're better off taking the bet IW's will die before they spend that much money in medical. Lower dolllar values and they jump at a C&R. It's there way to shift to Medicare. They have in the past screwed IW's by not providing the non-Medicare dollars.

    In a C&R, which would be the only time a WCMSA is necessary, the AA fees are based on the full amount of the settlement..that is true.

    Whether the settlement is indemnity only, or includes money for FMC, the bottom line is the same. It's a C&R, lump sum payment. Whether the allocations are MSA and Non-Medicare services...the end result is the same. It's the IWs money no matter how you look at it... CMS requirement is that a portion of the FMC award money is 'setaside'. It's still the IW's money to pay for that service/treatment required for the injury.
    Indemnity is indemnity...
    Future medical care money is FMC money. They are totally seperate. If there is no need for FMC, there would be no money for FMC, and the settlement would be limited to indemnity money only. The AA fees would still be based on that lump sum payment.Of course AA fees are to be paid on the MSA money... that is part of the lump sum.
    Just because the money is called MSA or FMC, lump sum cash payments are still just that. It's the allocations, where the money is directed, and how it's split up in the document language.
    There is no money deducted from any settlement.
    Whether there is a MSA required or not... there can still be the exact same dollar amount in a settlement that includes FMC. The same money goes to the IW... regardless of where the deposit is made. CMS just wants to know that part of the lump sum is 'setaside' as a guarantee. IW's still use the money for FMC. But, only for what Medicare would normally be paying to a regularly Medicare eligible beneficiary. A formal WCMSA is only necessary because the IW is Medicare eligible. (Or, in some cases where the IW is Medicare eligible through normal retirement.)
    As I said... carriers/IC are required to 'setaside' money to cover the exposure in all claims... its' called 'reserves'.
    Everyone, you, me and IW's and yes Dr's and drug dealers are supposed to protect MEdicare interests... its' out tax dollars paying those medical bills.

    But... In a PI claim, or WC claim, where an IW is receiving money up front to cover their future medical needs, that money is supposed to be used ONLY for that treatment. Drug dealers who are shot don't have money from any settlement, Like IW's do. Medicare wants to be sure there is no double dipping and shifting liability.
    Sorry... I don't see any scam here...
    Why should an IW be paid money for their treatment needs, and spend it elsewhere then ask Medicare to pay for treatment. You would not agree to that and neither do I or CMS.
    It never has been in the IWs best interests where future medical is anticipated to be extremely costly to close out or sell their FMC benefits. As long as the ER/IC is liable, they should be paying the bills. That is as long as the claim is open or medical is necessary.
    My man, You are playing with words.

    The higher the MSA, the bigger the Attorney's fees are pure and simple unless the IW is lucky and his Attorney does not get any part of the MSA off the front end.
    Also, It is negotiable. You can say it is not but in realty it is or there would be no dispute over the proposed MSA amount. The IW's Attorney wants the biggest MSA he can "slide by" CMS to pad his pocket. The IC's Attorney's want a low MSA slid by CMS which screws the tax payer because Medicare has to step in prematurely. Damn if you do, Damn if you don't.

    It is a known fact that the IC's try and send a low figure proposal past CMS. CMS does not filter every MSA proposal with a fine tooth comb so many do get by and approved.
    When this happens, Medicare has to step in and start paying. This causes a financial hardship on the IW(COPAYS,DED.) and also screws anyone who pays taxes because Medicare is taken out of our checks. Anyone who feels that a IC will not try and screw the Federal Gov. this way is blind.
    It is a damn if you do, damn if you don't scam.
    The IW will get screwed in the end.
    The proper way would be a cash settlement and a lifetime medical. One needs a excellent and honest Attorney to combat the woes of a MSA. Anybody seen one like this? LOL

    This is my humble opinion.

  9. #9
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    Default Re: Medical Set Aside

    Also, It is negotiable. You can say it is not but in realty it is or there would be no dispute over the proposed MSA amount.
    You may negotiate the amount of a FMC settlement, but you are not going to negotiate a WCMSA dollar amount with CMS/Medicare. There are no playing with words there. And, furthermore...there is no dispute resolution or appeal process with CMS. I'm not saying they will not ever adjuste a dollar amount that has been submitted... but you'd have to have compellling reasoning to support your claim to a different amount than CMS has approved.

    The bigger issue in any settlement of medical in a comp claim is the overall dollar amount of the FMC/Future Medical Care to begin with. Regardless of the amount CMS wants to see in a WCMSA... the settlement overall is still a Compromise and Release with the carrier.
    The money for FMC is still money to be used by the IW for FMC, regardless of where it's deposited. MSA is a confusing administrative job for an IW... who is not familiar with the Medicare mandates and process to begin with.

    If you/IW are in agreement that FMC money is to be used for treatment to your industrial injury... what difference does it make that CMS wants a portion setaside in a seperate account ? It's still your money to be used for treatment.

    I've read the info at the link you posted... those submission rules are in place to protect YOUR best interests as well as those of CMS/Medicare.
    Without the rules, you would not know where the dollars you are being offered in a FMC settlement were sufficient to cover the potential costs of additional medical treatment.
    The higher the MSA, the bigger the Attorney's fees are pure and simple unless the IW is lucky and his Attorney does not get any part of the MSA off the front end.
    Regardless of the allocations in a C&R/lump sum settlement, the atty is entitled to a fee. Doesn't matter where the fee comes from... and the IW still gets the money in the settlement.
    When this happens, Medicare has to step in and start paying. This causes a financial hardship on the IW(COPAYS,DED.)
    When the WCMSA money is exhausted Medicare does step in and pay the bills... BUT, if you've been reading what I said... you would know that I talked about ''non-MSA money... THOSE are the FMC dollars the IW is to use to pay the out of pocket costs associated with Medicare coverage. That is the second allocation in a FMC settlement.

    Whether the money is indemnity, spend any place you want, or non-MSA medical money, spend any place you want... or WCMSA money... spend only on what Medicare would normally be responsible for... what difference does it make. Settlement money is settlement money.
    The proper way would be a cash settlement and a lifetime medical. One needs a excellent and honest Attorney to combat the woes of a MSA. Anybody seen one like this? LOL
    That is possible and happens every day. There is no law that prohibits a cash payment of the indemnity due. Most states permit this, and some don't even allow for a commutation. Others have a statutory % discount to 'todays dollars'. The atty fee would be paid on the indemnity portion of a commuted lump sum payment. Some states have continuing medical access... otheres have a SOL on medical.
    What you dislike is being paid paltary sums for your injury, and when you are Medicare elilgible, being told where a portion of that money can go and what it can be spent on.
    'Where is the so called ''scam'' ? Kindly show me the ''woes'' of a WCMSA...(?)

    The IC's Attorney's want a low MSA slid by CMS which screws the tax payer because Medicare has to step in prematurely.
    I think you'll see if you take the time to read the current changes in the MSPA that CMS can and will come back on the parties in a settlement if Medicare interests are not adequately addressed in the language. There can be up to 3 times the payments made, and up to $1000/DAY in penalties for this failure to addrress the mandates. Not something any of those involved would care to be faced with. It's not over 'til the IW dies. Even if the MSA money is exhausted.

  10. #10
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    Default Re: Medical Set Aside

    As you know, the MSA is not a simple process and most IW's will get burned because of not understanding the process and legal fees.

    Many IW's do not realize fees come out of the MSA on the front end. If someone gets a $100k settlement and a $250k MSA, there actual upfront settlement at a 25% Attorney fee would be $70k not counting "office fees". I do feel it is damn wrong for a Attorney to be able to claim any amount off the MSA. Many IW's would be lead to believe the fees would only be 25% of the cash settlement.

    It is a difficult process to understand. Reading thru the post, I realize you have been around the WC Block for a while. Understand that most have not.

    The scam is a Attorney who intentionall drives the MSA up to pad his pocket. I hope that these Attorney's get caught and see bars.

    WC can be a dirty world. Understanding a C&R settlement may seem cut and dry to you but to the average IW, It is not.Their Attorney is there keystone and most Attorney's are money hungry and could care less about the IW.

    The IC's will rape the Feds if they can get by with it. It has been done so much in the past. I hope you are correct about the tighting up of this by CMS.

    http://www.intrustservicesonline.com...o_April_09.pdf

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