Posted on June 23, 2015 by Tower MSA Partners
Petro delivers more than 20 years’ experience in business administration, utilization review, case management, and pharmaceutical management to the fast-growing Medicare secondary compliance and MSA company.
“Martin’s clinical proficiency and business acumen, along with his MSA background, position him to run with our business model,” said Tower CEO Rita Wilson.
Most recently Petro was general manager for BioScrip Infusion Partners in Melbourne, Florida. Responsibilities encompassed management and profit and loss results for all departments, including operations, pharmacy, nursing, and customer relations.
“Tower is dedicated to reducing unnecessary medical and pharmaceutical overutilization on claims, getting ahead of potential obstacles to settlements and resolving all issues prior to preparing MSAs,” Wilson added. “Martin understands these issues and shares Tower’s proactive philosophy.”
A registered nurse, with a Bachelor of Science degree in nursing from the University of Pittsburgh and a Master of Business Administration degree from Nova Southeastern University, Petro started his career in utilization management and nurse case management. Previous employers include Broadspire, Gould and Lamb, and Express Scripts.
Posted on October 29, 2012 by Tower MSA Partners
For 20 years, the National Workers’ Compensation and Disability Conference® & Expo has been the industry’s leading training event. And this year’s event is taking it to the next level – making it the best ever!
Key NWCD presentation tracks include the following:
- A new full set of sessions will explore and deliver tangible, actionable solutions to the opioid crisis in workers compensation.
- New ‘Regional Differences Sessions’ will each tackle the most challenging issues in a particular area of the country and provide you with practical strategies to overcome them.
- New interactive ‘Think Tanks’ give attendees an opportunity to exchange innovative ideas with industry peers and leaders.
- Enhanced legal track for attorneys and non-attorneys via partnership with LexisNexis.
Click here for more info on NWCD.
And for those who seek the latest in optimized settlement and Pre-MSA intervention strategies, stop by Booth #936 to learn more about the challenges of the current CMS review model and what Tower MSA Partners is doing to save clients millions.
Tower Triage enables employers and carriers to:
- Mitigate CMS exposure
- Optimize patient care
- Expedite settlement
For more information , or to request a meeting with one of our executive team members, email us at email@example.com.
Posted on October 29, 2012 by Tower MSA Partners
Is an illegal immigrant working in this country entitled to benefits under the Workers’ Compensation statutes? This question was answered in the affirmative in the Delaware Superior Court case, Del. Valley Field Servs. V. Ramirez, No. 12A-01-007-JOH (Sept. 13, 2012).
Saul Ramirez began working as an independent contractor in April 2010, and then working as a regular employee an added to payroll in January 2011. Mr. Ramirez’s boss requested a Social Security number in order to include him on payroll. Responding to that request, Mr. Ramirez furnished a fake Social Security card.
Shortly after being converted to a full-time employee, Mr. Ramirez fell down some stairs and injured his back. The accident was witnessed by the company’s president and reported the accident. It was determined by the treating physician that Mr. Ramirez was totally disabled.
In February, the company was informed by the payroll service that Mr. Ramirez’s Social Security number was false and Mr. Ramirez was subsequently deported in March.
Employer argued that employee (Mr. Ramirez) was not entitled to Workers’ Compensation benefits because:
- Employee’s “fraudulent inducement” in falsifying documents to gain employment;
- Mr. Ramirez’s deportation suspended benefits;
- If Mr. Ramirez could not be lawfully hired pursuant to federal immigration laws, the State’s workers’ compensation laws were preempted.
The Board rejected those arguments stating that despite Mr. Ramirez’s illegal status and falsifying documents, he still qualified as an “employee” under the Workers’ Compensation Act (“Act”). The information Mr. Ramirez falsified was not the type of information that would make him forfeit his rights as the falsification did not pertain to his health, work history, or prior injuries.
Next, the Board stated that federal law did not prohibit the award of benefits to an illegal alien. Also, the inability of Mr. Ramirez to return to the United States for treatment did not forfeit his right to benefits as he was not “refusing” treatment as defined in the Act.
The main issue in this case was not one of immigration law, it was labor law. Mr. Ramirez was hired by the company to perform work. He was injured on the job and required medical treatment. There was no dispute about the actual injury. The employer received the bargained-for benefit of the employment relationship. This case has been appealed to the Delaware Supreme Court.
Posted on October 24, 2012 by Rita Wilson
Fight Against Prescription drugs
Another state takes up the fight against Prescription Drug Abuse….
“Kentucky House Bill 1, sponsored by House Speaker Greg Stumbo, passed in a special legislative session this spring and went into effect July 20. The bill included multiple elements to prevent the abuse and diversion of prescription drugs and to enhance law enforcement’s tools to investigate illegal prescribing practices. Since its implementation, 10 pain management clinics have closed, prescriptions for some of the most-abused controlled substances are dropping, and a record number of investigations are under way into suspicious prescribing practices,
For workers’ compensation carriers and employers, this is a tremendous victory in the fight to prevent prescription drug abuse by injured workers. We believe more states should follow Kentucky’s lead.
Posted on October 24, 2012 by Tower MSA Partners
She taught me a LOT!
My mother taught me TO APPRECIATE A JOB WELL DONE.
³If you¹re going to kill each other, do it outside. I just finished cleaning.²
My mother taught me RELIGION.
³You better pray that will come out of the carpet.²
My mother taught me about TIME TRAVEL.
³If you don¹t straighten up, I¹m going to knock you into the middle of next week!²
My mother taught me LOGIC.
³Because I said so, that¹s why.²
My mother taught me MORE LOGIC.³If you fall out of that swing and break your neck, you¹re not going to the store with me.²
My mother taught me FORESIGHT.
³Make sure you wear clean underwear in case you¹re in an accident.²
My mother taught me IRONY.
³Keep crying, and I¹ll give you something to cry about!²
My mother taught me about the science of OSMOSIS.
³Shut your mouth and eat your supper.²
My mother taught me about CONTORTIONISTS.
³Will you look at that dirt on the back of your neck!²
My mother taught me about STAMINA.
³You¹ll sit there until all that spinach is gone.²
My mother taught me about WEATHER.
³This room of yours looks as if a tornado went through it.²
My mother taught me about HYPOCRISY.³If I told you once, I¹ve told you a million times, don¹t exaggerate!²
My mother taught me the CIRCLE OF LIFE.
³I brought you into this world, and I can take you out..²
My mother taught me about BEHAVIOR MODIFICATION.
³Stop acting like your father!²
My mother taught me about ENVY.
³There are millions of less fortunate children in this world who don¹t have wonderful parents like you do.²
My mother taught me about ANTICIPATION.
³Just wait until we get home.²
My mother taught me about RECEIVING.
³You are going to get it when you get home!²
My mother taught me MEDICAL SCIENCE.
³If you don¹t stop crossing your eyes, they are going to get stuck that way.²
My mother taught me ESP.
³Put your sweater on; don¹t you think I know when you are cold?²
My mother taught me HUMOR.³When that lawn mower cuts off your toes, don¹t come running to me.²
My mother taught me HOW TO BECOME AN ADULT.
³If you don¹t eat your vegetables, you¹ll never grow up.²
My mother taught me GENETICS.
³You¹re just like your father.²
My mother taught me about my ROOTS.
³Shut that door behind you. Do you think you were born in a barn?²
My mother taught me WISDOM.
³When you get to be my age, you¹ll understand.²
My mother taught me about JUSTICE.³One day you¹ll have kids, and I hope they turn out just like you!²
Posted on October 24, 2012 by Tower MSA Partners
Court Urges Change in Florida Workers¹ Compensation Law. An appellate court is urging the Florida Legislature to reconsider a state law that makes injured employees pay employers¹ legal costs if they lose good faith workers¹ compensation appeals.
A three-judge panel of the 1st District Court of Appeal in Tallahassee made that recommendation in upholding such an order. It requires Gina Frederick to pay the Monroe County School District $11,834.
There¹s no dispute Frederick was hurt on the job, but two doctors disagreed on whether she had a permanent total injury. A medical adviser appointed by a compensation claims judge, though, offered the opinion she¹s not totally and permanently injured.
Frederick then withdrew her claim but still was ordered to pay the district¹s costs. The court noted the law on the other hand limits fees for workers¹ lawyers.
Copyright 2012 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Posted on October 18, 2012 by Tower MSA Partners
Tower MSA Partners will be a sponsor of the Annual WCCP Holiday Conference! The event will be held at the Intercontinental Hotel in Tampa, FL on November 30, 2012. Registration begins at 7:30 a.m., with the conference starting at 8:30 a.m. After a full day of education, be sure to join us for our Sponsored Holiday Reception. This year we will be partnering with the Rough Riders for our 1st Annual Teddy Bear Drive. While this is the end of our educational season, it is one of the Rough Riders first events of the year, so let’s make it memorable! Challenge your peers to see who can donate the greatest number of bears while increasing your chance to win the WCCP Holiday Door Prize. Teddy bears must be between 12″ and 16″.
Posted on October 18, 2012 by Tower MSA Partners
Tower MSA Partners will be sponsoring an After Hours CEU at the new Buca di Beppo in the Governor’s Square Mall in Tallahassee this Thursday, October 18, 2012, starting at 5:30 P.M. We will be presenting “Important Deadlines” for a 1hr Law credit and “Tips For Employers On How To Save On WC Cost”. Heavy hor d’oeuvres and drinks provided to make sure no one goes hungry.
Posted on October 10, 2012 by Rita Wilson
The Pennsylvania Commonwealth Court, in a decision published late last month, seized upon Fentanyl (ACTIQ), a highly addictive opioid, 100 times more powerful than morphine, when it ruled specifically that Fentanyl lozenges were not appropriate as treatment for a workers’ compensation low back injury. According to defense counsel, Ronald A. Varga, the decision of the Court “could be significant” as it provides carriers with “a mechanism to cut of this medication and switch to something else”.
The original dispute occurred after Utilization Review findings concluded that the Fentanyl lozenge was not appropriate and necessary treatment for a low back injury because of its highly addictive nature and because its only approved use is listed as end stage cancer pain. The original decision, made by the Workers’ Compensation Board, found that the risk of addictive and potential danger to the patient is a valid and reasonable basis for the determination of the appropriateness and necessity of a treatment regimen. Upon appeal, however, divided Workers’ Compensation Appeals Board (WCAB) overturned the decision, noting that the availability of alternative treatment options “does not, in and of itself, render claimant’s current pain management unreasonable or unnecessary”.
The Commonwealth Court, in its reinstatement of the original ruling, noted the following:
1. The utilization review process is the sole method for determining if a disputed treatment is reasonable and necessary.
2. In making its determination of reasonableness and necessity, it is entirely appropriate for UR reviewer to consider the risk to the patient.
3. The reviewer in this case was within his rights to “consider whether it is reasonable and necessary for a provider to expose his patient to the level of risk presented by a medication”.
4. The weight and credibility of a utilization reviewer’s findings is for the workers’ compensation judge to decide.
As a resource for other employers, it is likely that we’ll see this decision cited as justification to contest the use of this very dangerous opioid. If an employer or insurance company can obtain objective medical opinion that the treatment the patient is receiving is highly addictive and there are alternatives to the use of narcotics, this case will certainly support an effort to challenge the prescription.
For more information on the decision and its implications, see https://ww3.workcompcentral.com/news/story/id/b8df217867f36a5641fbd85e9bcb5dd7s (subscription required).
Posted on July 18, 2012 by Rita Wilson
A native of Atlanta, Georgia, Christy will be responsible for both southeast regional and national accounts for Medicare Set Aside and Medicare Secondary Payer compliance services. Christy has more than 15 years experience in providing cost containment services in the workers’ compensation and disability market.
Christy served the industry in various capacities, beginning her career as a registered nurse and case manager, and transitioning into sales more than 10 years ago. Prior to joining Tower MSA Partners, Christy served the workers’ compensation market in local and regional roles involving both management and sales specific to Medicare Set Aside, Pharmacy Benefit, and Case Management Services.
Christy received her nursing degree from Dekalb College School of Nursing and maintains her license as a registered nurse in the state of Georgia.
Tower is pleased to have someone with Christy’s solid reputation for professionalism, sales and service as part of our organization, and we look forward to participating in her many successes. Christy can be reached via email at firstname.lastname@example.org, or via phone at 678-787-9412.
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