Actos Lien Resolution Program


About the Program

The April 28, 2015, Master Settlement Agreement (the “MSA”) between Takeda and the Plaintiff Settlement Review Committee (the “PSRC”) established the ACTOS Resolution Program.

The settlement program includes requirements on the resolution and payment of medical bills, liens, and other potential rights to reimbursement, and provides that a Lien Resolution Administrator (“LRA”) will assist Program Participants with these requirements.

The PSRC and Takeda jointly selected the Garretson Resolution Group, Inc. (“GRG”), to serve as the Lien Resolution Administrator and manage the lien resolution program.

Frequently Asked Questions

Click below to view the answers to frequently asked questions regarding GRG's Actos Lien Resolution Program.

Overview

What is the ACTOS lien resolution program?
The April 28, 2015, Master Settlement Agreement (the “MSA”) between Takeda and the Plaintiff Settlement Review Committee (the “PSRC”) established the ACTOS Resolution Program.

The settlement program includes requirements on the resolution and payment of medical bills, liens, and other potential rights to reimbursement, and provides that a Lien Resolution Administrator (“LRA”) will assist Program Participants with these requirements.

The PSRC and Takeda jointly selected the Garretson Resolution Group, Inc. (“GRG”), to serve as the Lien Resolution Administrator and manage the lien resolution program.

What does the Master Settlement Agreement require?
As a condition precedent to the distribution of any Final Payments, Program Participants must follow specific procedures for identification and resolution of several categories of liens, i.e., address “lien gates” for both government and private healthcare payers.

Data and Forms

Will our clients be required to sign any forms for GRG to exchange information with governmental and private payers?
GRG prepared a “Qualified Protective Order” that was entered by the court.  This QPO authorizes the exchange of claimants’ protected information with GRG without individually signed HIPAA authorizations from claimants.

Do I need to submit data to GRG and BrownGreer?
GRG is working closely with BrownGreer to minimize—and hopefully eliminate—the need to submit the same information to multiple parties.

Lien Obligations in the ACTOS Settlement

What lien obligations will GRG handle?
As Lien Resolution Administrator, GRG is responsible for resolving all claims/liens asserted by Medicare and state Medicaid agencies, private insurance provider liens from plans who participate in the PLRP, and any other lien identified or submitted by a firm (non‐PLRP private, VA, military, etc.).


Lien Gates:
 

  1. Federal Medicare - LRA affirmatively verifies entitlement to Medicare Parts A & B and resolves obligations.
  2. State Medicaid - LRA affirmatively verifies entitlement to Medicaid (in the claimant’s state of residence) and resolves obligations.
  3. Private Insurance
  • Path 1: LRA affirmatively verifies entitlement to any healthcare plan participating in the Private Lien Resolution Program (“PLRP”).
  • Path 2: LRA resolves all payers reported by the claimant or attorney, or the claimant provides an affidavit that a payer did not pay for the claimant’s treatment.
  1. Notice - LRA resolves liens for which notice was provided to plaintiff attorney or defendant, and/or self‐reported by claimant. May include non‐PLRP private plans, military plans, or other governmental plans.
How is the lien resolution program designed; does it differ from other mass tort lien resolution programs?

In some ways this lien resolution program will be similar to the process that firms have used in other settlements; however, there are a number of important distinctions:

  • GRG is the single administrator handling Medicare, Medicaid and private lien resolution program (“PLRP”) obligations. This consolidated structure provides efficiencies that will allow for a fast, coordinated and transparent process.
  • Second, because of the period of time allotted for Program Participant enrollment and claims package submission to and adjudication by the Claims Administrator, GRG will have time to make significant progress on liens before payments are released.
  • Given the tremendous opportunity to set a new standard for lien resolution performance, GRG is using a simple, straightforward fee schedule, including fee reductions if defined timelines are missed.

Program Communication & Webinars

How will information about the Actos Lien Resolution Program be disseminated?

  1. Email: GRG has established an email distribution list to communicate important information about the Actos program. Please ensure that the appropriate members of your firm are receiving these updates. If you are unsure, you can email us at ActosLRA@garretsongroup.com.
  2. Portal: You can logon to the GRG client portal anytime to check the status of your cases, view payment information, and pull a variety of lien resolution reports.
  3. Questions? All inquiries should be emailed to ActosLRA@garretsongroup.com.


How do I add additional team members to GRG’s mailing list?
To have additional team members from your firm added to the email distribution list, please send a request to actoslra@garretsongroup.com


How do I access past webinars?
Informational webinars concerning the Actos Lien Resolution Program are posted on GRG’s Actos webpage. You can also access them directly here:

  • ACTOS Lien Resolution Introductory Webinar: GRG presented the ACTOS Lien Resolution Introductory Webinar on Friday, June 12, 2015. The presentation provides instructions on claimant data submission for lien resolution as well as updates on government and private programs. We walk through our new client portal that will provide you with important information throughout the Actos program. The recorded webinar is available here: https://web.garretsongroup.com/actos-lien-resolution-introductory-webinar
  • ACTOS Lien Resolution Program Update and Private Lien Resolution Program ("PLRP") Webinar: GRG presented an update on the ACTOS Lien Resolution Program, including an overview of the Private Lien Resolution Program (“PLRP”) on September 1, 2015. The recorded webinar is available here: https://web.garretsongroup.com/actos-lien-resolution-program-update

Client Portal

How will GRG’s new client portal support the program?
Throughout the program, comprehensive status reporting on information such as claimant-level milestones, lien amounts, and firm action items will be clearly presented on our client portal.

Learn More About  GRG's Client Portal

What information is available on GRG’s Portal?
The GRG ACTOS Portal will allow data to be aggregated and presented via a dashboard, which provides comprehensive views and downloadable reports across all lien types. You’ll have immediate access to program statuses and claimant–level milestones. Firm action items will be clearly presented resulting in a swifter and more efficient resolution process on all levels.


How to Access the Portal:

  1. Open your internet browser and go to https://portal.garretsongroup.com.
  2. Existing Portal clients must use their current username and password to access the system. Once logged in, ACTOS will appear as a new selection on the drop down menu for the Mass Tort Dashboard.
  3. New Portal users must select the “retrieve password” button from the Web Portal Login Page. Enter your email address, and an email prompt will arrive with your current password. If you do not receive an email within a few minutes, please check your spam folder. Once logged in, new users may update their password.
  4. If you encounter an error message or have any difficulties accessing information on the Portal, please send an email to actoslra@garretsongroup.com and we will assist you with resolving the problem. Please be sure to copy and paste the error message into your email and include a detailed description of what you were trying to do when you encountered the error.

How to Use the Portal:

  1. Once logged in, you will be immediately prompted with a HIPAA disclosure statement. Once you agree to the HIPAA terms, you will be directed to the homepage. 
  2. To begin viewing your firm’s ACTOS status, select “Mass Tort Dashboard” located at the top panel of the page. Select “ACTOS” from the program drop down menu. You will be directed to the Mass Tort Dashboard home.  
  3. From the Dashboard homepage, the Portal offers access to several reports including Lien Status Reports, Entitlement Reports and Discrepancy Reports. Simply navigate to the “Reports” selection from the Mass Tort Dashboard Bar. 
  4. The “Firm Action Items” present on the bottom of each dashboard will keep you abreast of any discrepancies that may exist and the action items needed to resolve them.
  5. If you encounter an error message or have any difficulties accessing information on the Portal, please send an email to webportalhelp@garretsongroup.com where we will assist you with resolving the problem. Please be sure to copy and paste the error message into your email and include a detailed description of what you were trying to do when you encountered the error.
Additional Portal Resources:

The Client Portal has an online tutorial which can help you to navigate through the many available functions the Portal has to offer. Once you have logged in to the Portal, click the “Help” button on the Navigation Bar. This will redirect you to an online tutorial and index which will address many questions you may have regarding the Portal.

There is also an instructional video to guide you through using the Mass Tort Dashboard.

Resolving Data Discrepancies

What is a data discrepancy?
A data discrepancy exists when a claimant's identifying information does not match the information that Medicare or Medicaid has on file (e.g., the agency has a partial match because its search returns a different last name). Discrepancies MUST be resolved in order for your affected clients to complete verification of entitlement, and resolution requires firm action.


What will happen if we do not take action to resolve a data discrepancy?
Until these Medicare/Medicaid discrepancies are cured we may be unable to release funds that would otherwise be ready for payment.


How do I resolve a data discrepancy?
Your firm may view and cure discrepancies on the GRG ACTOS portal. Instructions are available on the Mass Tort Dashboard by selecting “View Mass Tort Dashboard User Guide.”

Medicare Lien Resolution

How are Medicare Part A and/or Part B reimbursement obligations being addressed?
GRG worked with Medicare’s front office—the Centers for Medicare & Medicaid Services (“CMS”)—to establish a program to resolve ACTOS claimants’ reimbursement obligations to Medicare. This program addresses Medicare Parts A & B coverage, also known as “traditional” or “fee-for-service” Medicare coverage. Coverage under Medicare Part C plans, also known as Medicare Advantage plans, is being addressed separately.

GRG facilitated a “global” lien resolution strategy to satisfy and resolve Medicare’s Part A and/or Part B recovery claims for all Medicare‐enrolled participating claimants. A global program is an agreement by CMS to accept fixed reimbursement payments from Medicare-entitled claimants instead of pursuing individual, itemized claims. This provides favorable results for claimants and allows much faster processing of liens.


What does “global resolution” mean?
The term “global resolution” refers to an agreement with the Centers for Medicare and Medicaid Services (CMS) to resolve Medicare Part A and/or Part B reimbursement claims on an aggregate basis (as opposed to a claim‐by‐claim approach) based on values derived from compensable injury categories. Global repayment values are based on the routine costs associated with the medically accepted standard of care for the treatment and management of each specified injury category, taking into account the timing in which a claimant became entitled to Medicare vis‐à‐vis his or her date of injury and that resulting standard of care.


What are the global repayment values for my clients’ injuries?
Global repayment values correspond to each category of compensable injury in a settlement, and are based on the clinical guidelines for the medically accepted standard of care for the underlying injury.

Please note that the repayment values listed below are the maximum amounts. For specific claimants they may be adjusted downward in circumstances where a claimant’s Medicare enrollment date occurred after their date of injury, or where the claimant had alternate primary payer health coverage such as a group health plan or Medicare Part C plan.

Based on the information we are being provided from the ACTOS claims administrator and receiving from CMS, we are able to identify these circumstances and will work with firms to ensure claimants do not overpay or “double” pay Medicare or other health insurance providers.

For ACTOS, the maximum global repayment amounts are as follows:

I do not agree with my client’s Medicare Global repayment value.  Can I submit an appeal?
The firm may request a “Redetermination” of the assigned Global repayment value if the firm can provide documentation evidencing the claimant’s coverage through a primary payer while being treated for their compensable injury. To do so, the firm must complete and return a Redetermination Election Form. 

Will my claimants be responsible for repaying Medicare for future medical expenses related to their bladder cancer?
The agreement with CMS resolves all of Medicare’s interests “with respect to past and future medical care related to [ACTOS] settlements...” Put another way, the program ensures that a claimant’s future Medicare coverage—for ACTOS-related injuries or for unrelated needs—is free and clear of any entanglement or risk from the ACTOS settlement. In addition, a Medicare set-aside to fund a claimant’s future medical care is not necessary because all post-settlement considerations are resolved by the global program.

I received a notice from Medicare. Should I respond?
If you or your client received ACTOS-related correspondence from Medicare such as a Conditional Payment Notice, a Final Demand, an Intent to Refer, or a Denial of Benefits Notice, please notify GRG immediately at ActosLRA@garretsongroup.com. Neither claimants participating in the ACTOS settlement nor their counsel should contact CMS or its contractors to notify them of settlements or open records, as notification could result in duplication of recovery as well as issues with benefits coordination.

GRG exclusively handles all communications with CMS. Since fair reimbursement amounts are established on the front-end, CMS will not communicate directly with claimants nor provide written documentation of resolution. GRG will conduct the resolution process within the bounds of the global agreement and provide certification of resolution once the liens are paid.

Medicaid Lien Resolution

Is there a cap established for Medicaid liens?
GRG presents the state Medicaid agencies with a standard protocol agreement. The protocol proposes that Medicaid’s recovery claim is “capped” at a certain percentage of a claimant’s gross settlement award. Most states have agreed to a cap between 20% and 30%. Note that for Medicaid, most cases will be resolved for amounts significantly less than the cap. GRG audits each individual claim to ensure that the agencies are compensated only for injury‐related medical care.

Private Lien Resolution

Is there a Private Lien Resolution Program (“PLRP”)? If so, what are the terms and timelines?
Yes. There are three recovery contractors with plans participating in the PLRP - Benefit Recovery Solutions, MSP Group and Rawlings.  The health plans participating in the program cover the large majority of Americans that receive their health benefits through a commercial carrier, including some Medicare Part C and ERISA plans. Each of these recovery contractors had ninety (90) days to assert a lien on behalf of their plan(s).  Under the terms of the PLRP agreement, the cap for all PLRP liens ranges from 20-25% (depending on the size of the settlement award and other relevant factors). There is also a 45% offset for each lien that does not reach the cap. 


Is the PLRP required; are there other private lien requirements?
Claimants were automatically enrolled in the PLRP unless your firm specifically opted out. If injury-related treatment was provided under a non‐PLRP plan, that plan must be separately notified and addressed to determine if a repayment obligation exists. If a claimant opted out of the PLRP, 30% of the claimant’s gross settlement proceeds will be withheld in the QSF until resolution requirements are satisfied under the MSA. The same percentage applies to non‐PLRP private liens. Put another way, 30% of the gross settlement will be the maximum holdback amount for non‐PLRP private liens.

Lien Disclosure and Certification

My claimant was covered by an additional insurance provider that does not participate in the PLRP. How do I ensure that another lien does not exist? 
Garretson has affirmatively identified nearly all government healthcare providers and the large majority of private insurance carriers through our ACTOS lien resolution program. We estimate that up to 95% of government healthcare providers and private insurance carriers who may have a potential interest in your claimants’ settlements are being resolved through our program.

However, some claimants are subject to liens from other government healthcare providers (e.g. Veterans Administration) or private plans who are not participating in the private lien resolution program. As a condition precedent to payment, the settlement agreement requires the interest of these health coverage providers to be dealt with prior to payments being issued.

To help your firm meet this requirement, we have added a feature to our portal that allows streamlined disclosure of government and private healthcare liens that have not been identified by the ACTOS lien resolution program. The new page on the portal is designed for you to (1) if necessary, disclose potential liens that we have not already identified, and (2) certify that all known lienholder interests have been disclosed so payment can be processed when the Claims Administrator releases funds.


Can I disclose a lien for my client after my firm has certified his/her case?
Generally, no.  Once your client’s case is certified, GRG applies a lien holdback based on the liens disclosed at the time of certification.  That lien holdback is then in place at the time of payment, and funds are released accordingly.   GRG, in our discretion, may allow the disclosure of liens post-certification based on the status of your client’s case.  If you have a potential lienholder to disclose post-certification, please contact us at ActosLRA@garretsongroup.com for further discussion.


How do I complete this process on the portal?
To disclose the MSA disclosure and certification requirements, log onto the GRG ACTOS Client Portal and follow the instructions. Video instruction is also available at https://youtu.be/o6Dxji-UMAk.


What happens after I post my clients’ additional liens on the portal?
When you disclose a potential lien, we will immediately take steps to resolve it. If your firm has already resolved the interest, you will be prompted to tell us when you submit the lien.


When should our firm complete the lien disclosure and certification requirement? 
We recommend completing this step for claimants as soon as their points awards are accepted because disclosure (if needed) and certification is a required step before payments can be issued.

Lien Holdbacks

Where can I view the lien holdbacks?
The overall lien holdback for each claimant is located in the payment file.


Why is my client’s lien holdback higher than the inbound lien amount?
Claims amounts may change during the lien resolution process.  Therefore, GRG must withhold the program required lien holdback, regardless of the inbound lien amount, to ensure there are sufficient funds to pay the lien upon finalization. 


How are lien holdbacks determined?
Lien holdbacks depend on the type of lien pending.

  • Medicare:  Highest possible repayment amount (if not finalized)
  • Medicaid: Varies by state (most are 20%)
  • PLRP: 20%-25%
  • Non-PLRP Private: 30%
  • Other Government (TRICARE, VA and Indian Health Service): 33%

How was the PLRP holdback calculated?

Per the PLRP agreement, if a PLRP lien is pending, a holdback will be applied to allow for disbursement of funds. There is a cap on PLRP recovery which ranges from 5% to 25% of the gross settlement value, depending on the size of a claimant’s settlement and the extent to which the adjustment factors in the settlement agreement allocation matrix reduced a claimant’s final points. For example, claimants with awards of less than $250,000 have a 5%, 10%, 15% or 20% cap. Claimants with awards of $250,000 or more have a “sliding scale” cap of 20-25%, with the maximum cap—25%--applying only to awards of more than $1 million.

Fees

What fees will claimants be responsible for paying to GRG?

  • Program Fee: $125 per claimant. Includes all project management, reporting, affirmative verification of Medicare and Medicaid entitlement, PLRP enrollment and matching, and (as applicable) confirmation of no interest from any such payers.
  • Resolution Fee: $185 per lien. Includes satisfying and discharging Medicare Part A and/or Part B claims, Medicaid liens, and PLRP private liens.
  • “Other” Liens: $350 per lien. Any other healthcare liens that firms identify and want to submit to GRG for resolution will be handled “traditionally” (that is, case by case)
  • $750 cap on program and lien resolution fees. LRA fees will be capped at $750 per claimant (including the Program Fee and any Resolution Fees.


What are the performance timelines GRG is required to achieve to preserve its fees?
Fees will be subject to increasing levels of forfeiture (20%+25%+33%) if specific deadlines are missed and not cured within 30 days. Deadlines will be based on the milestone of service being performed—i.e. “verification of entitlement” vs lien resolution— as well as the type of lien.

Performance rules will be finalized upon completion of the PLRP (which will include rules that factor into GRG’s timelines). They will account for factors like incomplete data submissions, the periodic data transfers GRG makes to agencies/payers, and the timing of final award amounts to finalize lien values.


Where can I find the GRG fees that have been invoiced and paid to date for each of my claimants?
GRG Lien Resolution fee invoices are updated and paid on a monthly basis from the ACTOS Qualified Settlement Fund. Please note these monies are not being refunded to your claimants. The purpose of this report is to provide visibility for fees GRG has assessed for all claimants. These fees may not be final for those claimants who are still pending resolution of one or more liens. GRG Fees are held back prior to issuing any wire and have already been accounted for, therefore no action is required by your firm.

The GRG Fee Invoice is located among the PayGroup list on the GRG Actos Client Portal. To view the overall GRG Fee total, please do so by visiting the Payment Summary Report on the GRG Actos Client Portal and filter by PayGroup MT390000 (or subsequent label) or your claimant’s name.

Payments

Where do I go to see if my claimants are approved for payment by the Claims Administrator?
Log into the Garreston Portal. Select “Mass Tort Dashboard.” Select “Actos” and click “Refresh Dashboard.” 

Once your dashboard appears, select “Reports” from the middle, right hand side of the screen. A list of available reports will appear. Select the "Full Claimant Listing Report". An open/download bar will appear at the bottom of your screen. (Many users are currently accessing the portal—if the report fails to load after a moment, select “Retry”.)

Open the report and find column J, entitled “Settlement Group.” If a date appears, your claimant has cleared all BrownGreer requirements and will proceed through the lien clearance process for possible payment.

BrownGreer delivers new payment lists to GRG on the 1st and 15th of each month.  Please allow five business days from the 1st and 15th of each month to view your cleared BrownGreer claimants on our Client Portal.  If no date appears at that time or the date listed occurred in the past, but no payment was received, see the below section: An expected payment did not arrive – why?


Where do I go to see what has been paid?
Once the dashboard appears, scroll to the bottom right to find “Claimant Payments.” Your full payment amount and number of paid claimants will appear. Select either the amount or number of claimants and a payment summary page will appear. Click on the pay group to expand and contract each wire and view the claimant breakdown. 

Please Note: The payment type identifier “Attorney Fees – Gross” includes the total currently due to each claimant, inclusive of attorney fees, expenses and net award to the claimant.

You can view payment information in two reports: 

  • Payment Summary Report: Lists all claimants and their net amounts that total to each wire by payment date. 
  • Payment Detail Report: Provides detailed accounting of each claimant’s current Gross Award to Net Award (disbursed amount), identifying all related deductions (MDL, Lien Holdbacks, GRG Fees) and lien status totaling to the wire by payment group. Please note that a claimant may appear with multiple payment group numbers, if they received an initial payment and subsequent payment due to a lien holdback and/or GRG fee reduction. Payment reports will be available on the morning of scheduled payment dates.   


Having trouble reading the reports?
Simply email ActosLRA@garretsongroup.com. Our trained staff of Program Specialists are ready to answer any of your questions.


How are the payments to my client determined?
Interim Payments are made on a rolling basis to claimants who (1) have accepted the Claims Administrator’s (BrownGreer) final points award (or whose final points award have otherwise been determined via the reconsideration or appeals process) and (2) have been cleared for payment. The amount disbursed to your client is the Approved to Pay amount (as determined by the Claims Administrator), less MDL Fees/Expenses, GRG fees, and lien holdbacks.


An expected payment did not arrive - why? 

  • Wire Instructions: All payments are made by wire transfer, but some firms have yet to provide wire instructions. Wire instructions can be provided to the Claims Administrator on its portal. All wire instructions for a given payment wave must be completed and updated on BrownGreer’s Portal seven business days before a scheduled payment wave date. If you need assistance updating or providing wire instructions, please contact BrownGreer at ClaimsAdministrator@ActosOfficialSettlement.comPlease note: We do not issue checks. If you have submitted check instructions, please update the BrownGreer Portal with wire instructions.
  • Healthcare Lien Certification: In addition, some firms have yet to complete lien disclosure certification for some or all claimants otherwise cleared for payment. Lien disclosure certification can be completed (typically in a few minutes) on the Garretson portal. For further details visit the GRG Client Portal and follow the instructions to fulfill the MSA disclosure and certification requirements. Video instruction is available here.


My client does not have any liens pending.  Why did s/he not receive the entire settlement amount?
The Claims Administrator is only providing approval for interim payments at this time.  Depending on the claimant, The interim payment is 67% or 90% of the settlement award.  GRG expects that the Claims Administrator will approve the release of final payments in early to mid-2017.


How much are MDL Fees and Costs and how are they assessed?
MDL fees and MDL costs are common expenses in MDLs. In ACTOS, these are governed by MDL Doc# 5850 CMO: Holdback Order. In accordance with this order, an 8.6% holdback for common benefit fees (to be deducted from fees otherwise payable to a claimant’s counsel) and a 2% holdback for common benefit expenses are being withheld from all settlement payments. An illustration of how these assessments affects the release of funds and disbursement to claimants is provided below.