Thursday, June 25, 2009

Medicare HMO

Posted by Matt Garretson

Question:
I have a client who pays extra for Medicare Part B through AARP (United Health Care). Does the Medicare Part B carrier have a statutory lien or is it just contractual? New York Attorney

Answer:
He is probably paying for the AARP Medicare Supplement plan or it is a Medicare HMO. In that regard it would likely be a contractual right of recovery. These plans “may” have the same right of recovery of traditional federal Medicare, but they must have the “magic” language in their plan. See Care Choices HMO v. Engstrom 330 F3d 786 (6th 2003) saying these plans can create this reimbursement right if it is in their plan agreement with the Medicare beneficiary. There continues to be a debate as to whether state law applies (b/c these clearly aren’t ERISA plans) – the plan will argue that state law is preempted if they have contractual language since the language gives the plan a reimbursement right arising out of federal law (42 U.S.C. §1395mm(e)(4)).

Hope this helps.

My best,
Matt Garretson

Monday, June 22, 2009

Medicare Liens

Posted by Matt Garretson

Question:
We settled a case on behalf of one of our clients. We are disputing the amount of the Medicare Lien and have filed an Appeal with Medicare. We received a letter demanding payment and interest regardless of our dispute with Medicare and the pending appeal. Their Pro Forma Instructions state that we must pay the total amount plus interest now regardless of the pending appeal, and that if we are successful on the appeal the difference would be refunded.

Has anyone been successful in getting Medicare to waive the interest that's charged during the pendency of the appeal?

New York Attorney

Answer:
Assuming the disputed charges can be adequately substantiated, I recommend paying the agreed upon charges (less procurement offset). The principal of unrelated and associated interest will be waived if successful on appeal.

I also should add that Medicare typically only waives interest prior to a successful appeal if there is a mistake in the issuance of the final demand. In other words, if the case hasn't actually settled (funds weren't received or agreement wasn't signed) then they would consider waiving interest prior to successful appeal.

My best,
Matt Garretson

Medicare and Lien Claims

Posted by Mary Skinner

Question:
I have a client that was injured in a 3rd party liability situation and seeks medical services from a provider. Client is a Medicare beneficiary. Provider files lien (in excess of 120 days from release of patient) instead of filing for Medicare and billing supplemental insurer. Provider argues that it did not know patient was a Medicare beneficiary at time of treatment. Provider will not reduce billing/lien by reduction of "procurement costs". It is our argument that "procurement costs" would be the reduction of the lien by a proportionate share of our attorney fee/costs for total settlement of liability claim. Is this a valid argument?

Oklahoma Attorney

Answer:
As of May 2006 providers do not have to bill Medicare. If they choose, they can recover from the settlement proceeds for actual charges; they do not have to bill Medicare. However, once they submit a claim to Medicare it negates their right to seek recovery for actual charges. With that said, because they are aware now that that your client is a Medicare beneficiary, they can bill Medicare but they must withdraw their lien. They cannot have a lien and submit a claim to Medicare.

Please feel free to contact me if you would like to discuss further.

Mary Skinner

Tuesday, June 16, 2009

Subrogation

Posted by Sylvius von Saucken

Question:
I just had a very nice elderly couple come into my office. They were hit by an uninsured drunk driver. Luckily, they had 100k in uninsured coverage. Medicare is claiming a right to subrogation. I thought the right to subrogation was strictly against any monies recovered from a 3rd party. Am I wrong?

Answer:
The third party includes the UIM carrier. The MSP Statute (42 U.S.C. 1395y(b)(2)(A)) identifies the parties responsible for payment, and that is not limited to a third party tortfeasor. Instead, the language requires:

(2) Medicare secondary payer
(A) In general

Payment under this subchapter may not be made, except as provided in subparagraph (B), with respect to any item or service to the extent that—

(i) payment has been made, or can reasonably be expected to be made, with respect to the item or service as required under paragraph (1), or
(ii) payment has been made, or can reasonably be expected to be made under a workmen’s compensation law or plan of the United States or a State or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no fault insurance.

In this subsection, the term “primary plan” means a group health plan or large group health plan, to the extent that clause (i) applies, and a workmen’s compensation law or plan, an automobile or liability insurance policy or plan (including a self-insured plan) or no fault insurance, to the extent that clause (ii) applies. An entity that engages in a business, trade, or profession shall be deemed to have a self-insured plan if it carries its own risk (whether by a failure to obtain insurance, or otherwise) in whole or in part.

Our best,
Sylvius von Saucken

Medicare Set-Asides Post Settlement

Posted by Marlene Wilson

Question:
I resolve a lot of old no-fault medical only cases. A lot of times the insured has no attorney. If I see Medicare is involved, I usually get a CMS condensed payment letter and resolve the case. Sometimes it looks like we are paying for accident related medical, but potential for some payments to get through could exist, I suppose. The release we use protects and idemnifies us for past and future issues. I understand that CMS can go after anyone for past lien payments despite the language in the release. However, once a settlement has occurred (i.e. 20k to cover future medical costs) and insured agrees in release to use settlement funds for accident related medical expenses only, is there liability to the insurer in the future after the signing of the release? Is CMS's right subrogated to the actions of the insured post settlement? In other words, I suppose I can live with potential past exposure or liens (or relatedness issues), but once the settlement is paid, I want to be done with future exposure. What is my exposure if insured cost shifts to Medicare post settlement? Another question is if the insured is not currently on Medicare (or has some private health plan on Medicare) but gets it 10 years from now, post- signing of a release, and cost shifts MVA related expenses to Medicare. Does the release protect future exposure?

Michigan Attorney

Answer:
The Medicare Secondary Payer provisions state Medicare is always secondary to WC and other insurance, including no-fault and liability insurance. The Medicare Set Aside (MSA) obligation in a liability settlement, however, is only clear in a case where a definitive allocation for future injury-related medical expenses exists for a client entitled to Medicare, i.e. a verdict sheet or a settlement release with a definitive allocation.

When settling a liability case in which payment for future medical expenses are not specifically negotiated or if a release is implemented that uses broad language, such as "all claims past and future", the current standard is to facilitate a damages/recovery "reasonable person" analysis to determine if a portion of the recovery recognizes future injury-related care and then further determine the amount of future injury-related care for which Medicare would otherwise be responsible.

The standard to be applied to MSA analysis in liability settlements is "substantial compliance" grounded in good faith, appreciating the fact that MSA guidance does not yet exist for liability settlements. If, however, in good faith a reasonable person would surmise that an allocation for future injury-related medical expenses is appropriate, two options exist: i) identify the appropriate allocation and educate the client to ensure that those proceeds are spent down on future injury-related care or ii) contact the appropriate Medicare regional office, share the fact pattern of the case and determine whether they elect to review and approve the allocation.

GFRG generally only recommends an MSA be established in a liability case when: i) there is going to be a permanent shift of the burden of paying future injury-related medial expenses from the liable third party to Medicare; and ii) the settlement contemplates future injury-related expenditures. If you do not have both of these elements, you do not need to consider an MSA.

If you do have both of these elements, then look to the client’s Medicare entitlement status. If the client is not currently entitled and has no reasonable expectation of Medicare entitlement within thirty months, then no MSA is needed. If the client is entitled or has a reasonable expectation of Medicare entitlement within thirty months, then a damages/recovery evaluation should be performed. Part of this evaluation process involves determining whether there will be a future medical allocation (FMA) in the settlement. After performing the damages/recovery calculation, determine what percentage of the gross settlement is allocated for all medicals (past and future). Subtract from the total medical allocation the amount comprised of past medical expenses in the form of liens. If the claimant has a balance remaining in the total medical allocation, the analysis continues.

Next, investigate the client’s future injury-related care requirements (future cost of care). For those clients who are expected to have no further injury-related care, obtain a letter from their treating physician stating that, to a reasonable degree of medical certainty, the client will no longer require any Medicare covered treatments related to injuries sustained in the incident. If the client requires future injury-related care, look to the amount of the future medical allocation compared to the future cost of injury-related care for which Medicare would otherwise pay. GFRG recommends a liability MSA be funded on behalf of the client for the lesser of the two numbers. GFRG can provide a recommendation as to whether CMS approval of the liability MSA should be obtained.

Medicare’s right to recover is from the date of the injury through the date of the settlement. If you settle a case for a claimant that is currently not Medicare entitled and has no reasonable expectation of entitlement within thirty months, then Medicare will not have an interest in the settlement.

Hopefully, we have addressed your issues; however, attached are two documents for your review. The first document is our position paper regarding the need for liability MSAs; the second is our articles about the MMSEA provisions and how this affects the settlement community. Please let us know if you have any additional questions.

Our best,
Marlene Wilson

Annuity DRA Compliance

Posted by Sylvius von Saucken

Question:
Does an annuity purchased as part of a settlement for a 20 year old plaintiff in a medical malpractice case that will be assigned to a (d)(4)(A) trust need to be DRA-compliant? I am particularly interested in your view about unequal payments (a future bump up in the annuity).

Thanks.
Vermont Attorney

Answer:
Generally, whether or not an annuity needs to be DRA-compliant when paid to a private special needs trust will depend on the state's annuity rules. For example, in Ohio, this question has been raised at an administrative appeals level, and the Ohio DJFS has opined that because a structured settlement annuity is not an asset of the special needs trust, that it is to be counted separate and apart from that of the trust's other non-annuity assets.

At the same time, arguments exist that the DRA's annuity rules are not intended to apply to third party funds used to purchase structured settlement annuities for the benefit of a long-term care beneficiary.

This brings us to a core issue - what type of Medicaid benefits does the 20 year old receive? If Aged, Blind or Disabled Medicaid, arguably, the DRA does not apply anyway, because the transfers of asset rules in general, are only intended to apply to long-term Medicaid. The DRA itself, under 42 U.S.C. Section 1396(p)(c)(1)(G), only applies to annuities purchased by or for an individual who has applied for long-term care Medicaid as noted below:

"(G) For purposes of this paragraph with respect to a transfer of assets, the term “assets” includes an annuity purchased by or on behalf of an annuitant who has applied for medical assistance with respect to nursing facility services or other long-term care services under this subchapter unless—"

So, if the disabled 20 year old is not receiving nursing facility or other long-term care services, the DRA's annuity design rules would not apply.

Presuming no other exceptions for DRA application exist, if the DRA applies to annuities used to fund special needs trusts, then unless state law provides otherwise, the annuity will have to meet the rest of the (G) tests, namely that the annuities be:

(1) Irrevocable and nonassignable;
(2) Actuarially sound (as determined in accordance with actuarial publications of the Office of the Chief Actuary of the Social Security Administration); and
(3) Provide for payments in equal amounts during the term of the annuity, with no deferral and no balloon payments made.

For example, in Ohio, an annuity includes a fixed payment or a payment for a term of years, and specifically permits a commutation of the annuity payments upon death if the annuitant dies within a guaranteed period. Ohio, then has defined the annuity rules, even for annuities purchased or changed after Feb. 8, 2006 as only requiring such immediate pay, fixed amounts, paid over the expected life expectancy with no deferral or balloon payments to include only payments made during the annuitant’s life. Otherwise, the accelerated payments made at death (to help pay for estate taxes as a rationale) would be considered an accelerated payment.

The challenge then, is to determine what your state would do to unequal payment amounts. Absent going to a state fairness hearing or arguing in state court, if the true objective is to protect state (long-term) Medicaid benefits, we would recommend taking a conservative approach and not designing an annuity, even if payable to a private or pooled special needs trust as able to make staggered, unequal lump sum or otherwise non-equal payments absent approval from the client’s case worker, and in some instances, without a letter from the state’s Medicaid policy experts (typically an in-house attorney at the state Medicaid offices), or an Asst. Attorney General for the state.

Please let us know if you have any follow up questions. (This answer is for educational purposes only, and does not constitute legal advice. You should seek legal counsel in your state to further discuss the concepts discussed herein and their application to specific fact patterns.)

Our best,
Sylvius von Saucken

Monday, June 15, 2009

MMSEA Extension Act of 2007

Posted by Matt Garretson

Question:
Has anyone decided that letters need to be sent to present clients in reference to the MMSEA Act of 2007? Has anyone made a determination that this act and its implications be incorporated in some form into new fee contracts? If any of you have such language or a form letter it would be a great resource because this is a matter that needs to be addressed with clients prior to resolving cases after the first of July. Any input or thoughts would be appreciated. It does not appear something that the defense is going to ignore.

Thank you.

Georgia Attorney

Answer:
Here is a draft document we developed for the mediation setting and an upcoming CLE teleseminar. You might be able to use that document as well as educate your clients on these three key points:

1) Because of this new legislation, you will be starting the process early to verify and resolve Medicare’s reimbursement interest in the client’s claim.

2) At the time of any settlement you and the client should be prepared (by using this form attached) to stipulate that the key data points be reported by the defendant to Medicare. This is especially critical with respect to the defendant’s reporting of injury description. (You want them to report the injury EXACTLY how you described the injury when you initiated the reimbursement claim well before settlement. If the defendant reports the injury description beyond the scope of what you reported, this could lead to potential increases in the reimbursement obligation or worse yet, a demand for additional lien payments after you have resolved the case and disbursed to the client.)

3) While nothing in MMSEA says that Medicare Set Asides are now required in liability cases (there has been no guidance or directive from Medicare that MSAs are required in liability cases), defendants may interpret the new law differently. In this regard, should the case settle you/client might be required to… (argue the point, compromise; seek opinions from third parties, etc).

With respect to fee agreement language, you might check out the article at the following link: “Sharpening Your Most Important Tool: Does Your Retainer Agreement Still Cut It?” for some pointers. Sample fee language could include: “We understand that current law and regulations regarding Medicare, Medicaid or private health insurance plans (Healthcare Providers) may require all parties involved in this matter (client, law firm defendant, and any insurance companies) to compromise, settle, or execute a release of Health care Providers’ separate claim for reimbursement/lien for past and future payments prior to distributing any verdict or settlement proceeds. We agree that the law firm may take all steps in this matter deemed advisable for the handling of our claim, including hiring separate experts/case workers who assist with resolving any Health care Providers’ reimbursement claims or liens for past and/or future injury-related medical care. The expense of any such service shall be treated as a case expense and deducted from our net recovery and shall not be paid out of the law firm’s contingent fee in this matter.”

I hope this is helpful.

Matt Garretson

Sunday, June 7, 2009

Medicare waiver?

Posted by Mary Skinner

Question:
We have a client who is 84-years-old. He was in a car accident last July. An uninsured motorist hit him. The other driver was found to be completely at fault.

Our client's Medicare lien amount is roughly almost 100K. Most of the injuries he sustained were pre-existing but were exacerbated by the accident. His UIM coverage is 100K. Despite the client's age, he was still working part-time up till the time of the accident. He was receiving SS-retirement.

Here is where the story gets tragic. The man, being 84, has a 40-year-old mentally handicapped daughter with epilepsy who receives SSI-disability. His daughter has a child who is 14-years-old and was recently diagnosed with epilepsy about 3 months ago. The 84-year-old man, who has no savings, was caring for both his daughter and his granddaughter. The man owes 90K on his home. He is about to get foreclosed on. We are doing everything we can to help keep him and his family in that house. His current income now is maybe 1K a month from his SS benefits and his daughter’s SSI. His monthly mortgage eats up all of that money.

We have a tentative agreement with his insurance company to get his entire policy limits. Our attorney handling the case has already agreed with the client to significantly reduce his fee so that the client will have as much money as possible to live on. The problem is reducing the Medicare lien.

I would imagine that this scenario would justify a total waiver by Medicare. However, the MSPRC lady I spoke with today informed me that maybe 1% of all financial hardship waiver requests are completely waived. However, if the waiver is submitted before a pre-settlement compromise letter, then the client is foreclosed from submitting the compromise letter, and there is no negotiating with the response by Medicare from the waiver request. If this is true, what would be the best way to pursue negotiations with Medicare so that we can help this man get everything he can from his settlement?

Answer:
Being that there are only policy limits available and if your client is still treating, I suggest that you settle the case and “stop the clock” on Medicare’s interest in the case. Medicare can only recover from date of injury through date of settlement. However, without knowing what Medicare’s conditional payments are to date it is hard to determine which would be the best avenue for you to take, a compromise or a waiver. If you pursue a compromise either, pre or post, and you do accept the compromise, there are no appeal rights. If you do not accept the compromise you can still pursue a waiver. With that said, based on the fact that your client has a disabled daughter and granddaughter whom I am assuming he supports in some manner, should you decide to pursue a waiver, submitting the waiver based on the following argument would be appropriate:
Full recovery defeats the purpose of Title II or XVIII of the Social Security Act. Reimbursement to Medicare would cause financial hardship and prevent the beneficiary from meeting necessary and ordinary living expenses, which include taxes, medical expenses not paid by Medicare or other insurer, support for dependents, miscellaneous expenses for which the beneficiary is legally responsible, as well as out of pocket expenses incurred, the age and income of the beneficiary, monthly income and expenses, and the physical and mental impairments of the beneficiary.

A waiver is “forgiveness” of a party's obligation to satisfy Medicare's claim, in whole or in part, if certain conditions are met. CMS may waive all or part of its recovery in any case where an overpayment under Title XVIII has been made with respect to a Medicare beneficiary who is without fault AND when adjustment or recovery would either defeat the purpose of Title II or Title XVIII of the Act (repaying Medicare would create a financial hardship), OR be against equity and good conscience for the beneficiary to repay Medicare.

Waiver requests must be submitted in writing to MSPRC, the Medicare contractor. The request cannot be submitted until settlement has been reached, and MSPRC has issued its final demand (with procurement costs deducted). Upon receipt of the waiver request, Medicare will send waiver forms, using SSA Form 632K, which will need to be completed. Waiver determinations generally are completed within one hundred twenty (120) days of the date a waiver request is received. If the MSPRC waiver determination is unfavorable you may appeal the determination.

A compromise represents the acceptance of less than the full debt owed to Medicare. A compromise may be granted if the debtor does not have the present or prospective ability to pay the full amount of Medicare's claim. Whether or not a compromise will be granted depends on a number of factors and each matter is considered on a case-by-case basis. A compromise may be requested at any time after you have determined that Medicare has made conditional payments, before or after settlement. There are no appeal rights once you have accepted the compromise.

A compromise can be reached either pre-settlement or post-settlement. Only CMS has the authority to negotiate a compromise, so the beneficiary's request will be forwarded to the appropriate Regional Office.

I hope this helps. I would be happy to assist you further should you need us.

Mary Skinner

Wednesday, June 3, 2009

Social Security Disability Insurance

Posted by Sylvius von Saucken

Question:
I settled a disputed liability case 5 years ago involving a woman who walked out in front of a car and was hit. She was critically injured, lost her leg, $920k in medical bills, etc. Amazingly, the defendant's insurance carrier chose to settle the case for the policy limits of $50k. At the time, the client was not on Medicare and only had TennCare BCBS. Given the disputed nature of the claim, and the fact that the settlement was grossly inadequate, BCBS agreed to waive their subro. Also, Vandy agreed to waive their substantial lien.

I have just received a message today that SSDI has now decided to stop her checks because she received the settlement in 2004. Obviously, there was no MSA at the time because she was not receiving Medicare and there was no recovery for future medical care anyway.

In addition to informing Medicare of the disputed claim, the BCBS waiver, etc., what do you recommend that I do?

Answer:
Social Security Disability Insurance (SSDI) is not based on income or assets, but rather work history and a qualification of disability. As a result, unless the case was a workers’ compensation claim, Social Security has no offset statute to trigger an overpayment process.

On the other hand, if the client is receiving $674 or less from Social Security, it is likely the case that SSI (Supplemental Security Income) is being reduced, because that would be based on income being less than threshold amounts (back in 2004 that would have been close to $579 per month) and assets being less than $2,000 (excluding the value of certain assets such as a home or car).

The best way to figure this out is to ask for a copy of the client’s Social Security letter (which she receives each year, around December), which tells her how much she will get (with Cost of Living Adjustments, etc.) for the coming months and why. She can also request a one-page benefits summary from her case worker that will properly identify the type of Social Security benefits received.

IF SSI, then there would be a repayment issue, but that follows very specific procedures, and there is an opportunity to minimize the reduction of SSI as part of that process.

Our best,
Sylvius von Saucken

Tuesday, June 2, 2009

Form 5500

Posted by Matt Garretson

Question:
I’m looking at a Form 5500 on a plan where I’ve received notice of a reimbursement claim. At line 9a of Form 5500 the boxes for both “Insurance” and “General Assets of the Sponsor” are checked as to the funding arrangement, and at line 7 of Schedule A, the box for “Health” is checked. If there is any self funding, does that bring the plan within 29 USC§ 1144(a) with respect to preemption?

Also, this was a 2008 injury, but the 2008 form 5500 is not yet on FreeErisa.com, just the one’s for ‘06-‘07.

-Georgia Attorney

Answer:
It is possible that “Insurance” is checked b/c the plan purchased stop loss insurance. In the past, courts have held that the existence of stop loss does not bring the plan under the cover of state insurance law b/c the insurance is meant to cover the plan and not insurance the plan beneficiaries. So, as a general rule, the existence of stop loss doesn’t mean the plan cannot avail itself of ERISA preemption. BUT, you should investigate the “stop loss trigger” threshold… In recent opinions, courts have said if the stop loss trigger is under $25K, then it is really acting like insurance on the beneficiaries and should be subject to state law (it is worth investigating and perhaps arguing). Also, you should argue that the state law defenses are still valid against any portion of your client’s medical expenditures by the plan that were covered by the stop loss policy.

I hope that helps. Mark Maughan runs our single event lien resolution operations and can be available to assist should you need us!

My best,
Matt Garretson

Monday, June 1, 2009

Medicare Lien After Settlement

Posted by Mary Skinner

Question:
I settled a tort claim [auto] on 4/2/09 for policy limits,the client went on Medicare on 5/1/09, and she may need ongoing treatment. Do I need to be concerned about a Medicare lien?

-South Carolina Attorney

Answer:
No, you don't need to be concerned about a Medicare lien. Medicare's right to recovery is from the date of injury through the date of settlement. Because you settled the case prior to your client becoming entitled to Medicare, Medicare does not have an interest in the settlement.

-Mary Skinner

Required Set-Aside for LMSA

Posted by Sylvius Von Saucken

Question:
Someone told me the law required setting aside an amount for an LMSA in a $200,000 settlement.

Answer:
Simply put, the “law” that gives you any indication of the need for set asides only applies to workers’ compensation cases in all cases that do not involve a specific allocation of future (medical) costs of care for which Medicare would otherwise pay. (See 42 C.F.R. §411.46 reproduced here):

“Medicare will not pay for any medical expenses related to an injury after settlement until the time the portion of the settlement allocated to future medical expenses covered by Medicare is fully exhausted.”

Creating any MSA, requires you find two elements:

1. Future costs of care (FCC) as part of an agreed allocation; and
2. Permanent burden shift of payment (PBS) of that care over to Medicare.

Simply stated, in LMSAs, FCC + PBS = need to determine MSA.

Absent both of these elements, you do not have a LMSA issue. If you have both elements, then the value of the FCC becomes the ceiling for an MSA, but not the MSA. At that point, you would consider your life care plan (if you have one), and redact out all those items Medicare does not cover (homes, cars, non-medical equipment, services, etc.), leaving the ones Medicare would. Then you take a look at the value of actual services to be rendered and perhaps, using structured settlement annuities, use present dollar values to cover the FCCs (except for the first 2 years of meds, which is part of the seed money).

As a result, settlements must “adequately consider” Medicare’s interest, no shifting of Medicare to be primary payer for past & future medical care. We do not want to leave you with anything but a better understanding that MSAs are all about protecting your client’s Medicare card. In workers’ comp cases, situations suggesting use of MSAs are more easily identifiable because of the non-fault nature of those cases. CMS provides 12 non-statutory policy memos for Workers’ Compensation MSAs because they can easily identify the three buckets of damages (indemnity, past meds, future meds).

Liability cases have more buckets and they have more detail behind them. So if you have a case where your client is injured, is receiving Medicare, and the defense has agreed to provide funds for a future surgery, as an example, where you settle a case involving a large settlement and a loss of a limb, you can hardly argue that FCC and PBS do not exist. In those circumstances, showing the damage allocation, calculating the expenses to Medicare, and documenting your file properly are the ways to properly consider Medicare’s interests and protect your client’s Medicare card.

To suggest that a $200,000 liability settlement with no allocation for FCCs as part of the negotiations requires an LMSA is taking part in the fear-mongering intended, in my opinion, to help continue an MSA industry.

I trust this has been helpful. Finally, anyone who tells you that MDSs are a requirement, should be pointed in the direction of a House Bill, sitting in the Sub-committtee on Health since June, 2007, H.R. 2549, which purports to create the very statute that this person is claiming exists.

We have, some might say, been on a mission to debunk the LMSA myth and to properly show counsel how to address these issues of interpretation of Federal rules and guidelines. As you can see, we take this job very seriously and would be very pleased to further discuss these matters with you at your earliest convenience.

Our best,
Sylvius von Saucken