Our partner Nicole Graci was recently successful  in extinguishing a $282,462.00 conditional payment notice issued by CMS involving a World Trade Center workers compensation claim. This matter raised new questions about the coordination of benefits between the Medicare Secondary Payer act and the World Trade Center Health Program. While CMS does not publish detailed reasoning in its initial decisions, the results suggest that both traditional and new conditional payment defenses can and do apply, even at the notice level.

 Nicole advises payers navigating similar issues not to limit conditional payment defenses to causal relationship. She notes that there are often other valid grounds to dispute them. We congratulate Nicole on her victory and invite our clients to contact us to learn more about our conditional payment practice or discuss a specific case where conditional payments are an issue.

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