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5th Circuit: No Conflict between MSP and Preauthorization Rule

By Jim Sams (Senior Editor)

Wednesday, May 15, 2013 | 0

The federal Medicare Secondary Payer Act does not preempt a Texas workers' compensation statute that requires a claimant to receive preauthorization from a carrier before undergoing surgery, the U.S. 5th Circuit Court of Appeals ruled on Tuesday.Case: Caldera v. The Insurance Co. of the State of Pennsylvania, 12-40192, 05/14/2013.Facts: Guadalupe Caldera injured his back at work in 1995. The Insurance Co. of Pennsylvania paid workers' compensation benefits.Caldera, while still suffering from the back injury, applied for and obtained Medicare benefits in 1998.Caldera underwent two spina...

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