A colleague recently asked me what happens to the funds placed in an established Medicare Set-Aside when the injured employee/beneficiary dies before the funds are completely exhausted. Since my legal responsibility usually ends once an MSA is established I did not readily know the answer to this question and I had to dig through old policy memorandums issued by the Centers for Medicare and Medicaid Services (CMS) to find the answer. According to the policy memorandum issued on April 22, 2003, (more…)
Medicare Secondary Payer Act
Violating the Medicare Secondary Payer Act Can Hurt Insurers’ Bottom Line
Not accounting for Medicare’s interest during workers’ compensation settlements can lead to shortfalls in insurers’ bank accounts. Under the Medicare Secondary Payer Act (MSP), the Center for Medicare and Medicaid Services (CMS) has the right to seek reimbursement of medical expenses paid by Medicare, which the workers’ compensation carrier should have made. [1] The Act requires that insurers consider Medicare’s interest during claim settlement and reimburse the Center for expenses paid towards treatment of the Medicare beneficiary’s work related injury. Participants in a settlement who fail to adhere to the Act’s rules may find themselves accosted with fines and significant liens. Developing a Medicare Set-Aside allocation can protect the parties from these fines. It also gives the parties a realistic projection of the claimant’s future medical cost and provides the opportunity to base settlement negotiations on this number.
[1] 42 U.S.C. §1395y (b)(2)(B)(i)(ii)(iii)
