| According to federal law, Medicare is precluded from
paying for a beneficiary’s medical expenses
when payment “has been made or can reasonably
be expected to be made under a workers’ compensation
plan, an automobile or liability insurance
policy or plan (including a self-insured plan),
or under no-fault insurance.”
In other words, a compensation
settlement cannot shift the responsibility
of paying for injuries and resulting treatments
to Medicare. When a claim is settled,
Medicare requires that its interests are
taken into account and Medicare is protected
from having to pay for any of the medical
expenses associated with the injuries. This
is accomplished through an agreement with
CMS known as a "Medicare Set-Aside"
which sets a specific dollar portion of
the injured persons settlement for future
medical costs.
Failure to reach an agreement with
CMS can be catastrophic. Enforcement
measures may include recovery from representatives
as seen in a recent action against a plaintiff
attorney by the government. The attorney
claimed that by merely advising CMS of the
settlement that CMS consented to the payment
of the settlement proceeds. The Court disagreed
with the attorney’s contention and ruled
that CMS had a right to collect directly
against the lawyer for costs of $10,000
plus interest. Additionally Medicare may
in the absence of agreement assume that
the entire settlement amount is allocated
for medical costs and will not provide coverage
until that amount is spent on medical services,
leaving the client unable to spend settlement
dollars for any other expense.
WNY Legal Nurse Consulting
offers complete Medicare Set-Aside Allocation
services (MSA). All MSA’s are prepared by
Medicare Set-Aside Certified Consultants.
Allocations are developed following thorough
review and evaluation of injury related
medical costs normally covered by Medicare
and provided in CMS approved formats. Once
completed we can submit the digitized plan
documents directly for CMS approval which
protects your clients future.
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