Fundamental Principles Governing the Medicare Secondary Payer Act and Medicare Set

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The basic premise of the MSP is that because Medicare pays covered persons’ medical bills with tax dollars, it is in the public’s interest that employers and tortfeasors, who by definition are responsible for the harm that necessitated the medical bills, reimburse Medicare for these work- related or tort generated costs. Most plaintiff’s lawyers are familiar with subrogation claims asserted by Medicare for past medical bills, and have experience in negotiating and paying these subrogation claims. The issue becomes particularly complex regarding future medical benefits for a person already on Medicare, or who has a “reasonable expectation” of Medicare coverage within 30 months of settlement of their claim. The MSP requires these future costs to also be paid out of the settlement or recovery, with the money to be held by the person until payment of these future medical expenses in a “Medicare Set-Aside Trust.” While the principle that an employer or tortfeasor should pay these expenses may seem fair in the government’s eyes, the devil is, as they say, in the details of how the government would enforce this obligation. The issues of who is required to establish such a trust, how much money should fund it, and what to then do with it, have been addressed by the federal government in workers’ compensation cases, but not in liability cases. Hence, the tremendous uncertainty surrounding this subject in liability cases .
Source: yjblaw.com

Protecting Medicaid, Medicare Liens, Settlements, & Set

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Source: mcssl.com

Workers’ Compensation Medicare Set Aside Arrangements

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Source: cms.gov

Workers’ compensation and payments

If you settle your workers’ compensation claim, you must use the settlement money to pay for related medical care before Medicare will begin again to pay for related care. In many cases, before a settlement is reached, the workers’ compensation agency asks Medicare to approve an amount to be set aside to pay for future medical care. Medicare will look at certain medical documentation and approve an amount of money from the settlement. This money must be used up first before Medicare starts to pay for related care that’s otherwise covered and reimbursable by Medicare.
Source: medicare.gov

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