Medicare Set-Aside Programs

Worker’s Compensation carriers are now required to consider and protect the interests of Medicare when settling claims Workers Compensation claims. Under Federal law, any entity found to have protected Medicare interests in future medical costs can be held liable for double damages.

In order to protect Medicare interests, an appropriate amount of settlement money must be “set-aside” for the payment of future medical costs that would otherwise be Medicare compensable. And under certain circumstances, the amount to be set aside must be approved by Medicare.

Coordinating Medicare and Worker’s Compensation benefits can be a complex challenge for any claims organization.  Making sure Medicare set-aside allocations are accurate and meet the proper standards has become a vital component of many claims.

To assist Worker’s Compensation carriers in meeting these obligations, our Medicare Set-Aside Program determines the appropriate set-aside amount based on an expert analysis of the condition, current treatment, projected future treatment, and life expectancy. Our highly trained staff of set-aside allocators, is then able to secure Medicare approval through a Medicare Set-Aside Proposal submitted to the Centers for Medicare and Medicaid Services (CMS).