North Carolina trial lawyer Chris Nichols has written a very useful description of how the Medicare Set Aside rules work in workers’ compensation cases. He also notes that federal law also permits Medicare to pursue Set Asides in liability cases (although Medicare has not yet done this).
Chris describes the concept of a Set Aside as follows:
The concept of the law is that Medicare is a "secondary payer" when any other form of insurance exists to pay claims. Before 2001, that meant traditional health insurance, but starting in 2001 Medicare began to interpret that to mean that even third party insurance, specifically Worker’s compensation settlements that "cut off" future medical benefits (clinchers), would be subject to the Medicare Secondary Payer regulations. This meant that any Workers Compensation clincher that resaonably cut off future workers compensation benefits would have to be reviewed by CMS to determine if there should be an MSA "allocation." Accordingly, Medicare would look at the case and decide what the future medical costs for the injury would be. The future costs would be placed in a MSA trust for the payment of medical services related to that claim.
We frequently have to deal with Medicare in large settlements, and often the Set Aside negotiations can add time and aggrevation to a settlement. However, Medicare Set Asides are often a fact of life that we must be aware of prior to entering settlement negotiations.
[tags] Medicare Set Aside, Medicare Secondary Payer, Georgia Workers’ Compensation, Workers compensation settlements, Medicare lien [/tags]
Jodi Ginsberg
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