There has been much discussion on liability MSA’s. Are they needed? Not necessary? Conflicting reports and a statement by the AAJ has continued to make things complicated. As a Medicare Set Aside allocator, my position is that Medicare’s interest must be protected per Section 111 of the MSP. I have outlined a simple equation here for quick reference.
Mr. Synder recented posted a comment on LinkedIn as to his thoughts. I found it well stated.
Link to statement by AAJ
Nothing in the quotes AAJ cites undermines the insurance industry’s position. Medicare could always seek reimbursement of a conditional payment from the insurance carrier– as well as from the plaintiff’s attorney! The new reporting law allows Medicare to connect the dots and deny payment for treatment which matches the body part code, diagnostic code and occurrence date of the report.
Any plaintiff’s attorney who tells his client that an allocation, i.e., set-aside, is unnecessary puts the client at risk for loss of Medicare benefits, and possibly is putting his/her own E&O insurance on the line.
By Teddy Snyder (Linked IN)
{ 3 comments… read them below or add one }
We have found that more and more of our plaintiff clients are requesting MSAs (whether or not they submit them to CMS) in order to “account for Medicare's interests” in these cases. I think to not have an MSA, especially in a high dollar liability case with significant future medical needs, is a risky proposition.
We have found that more and more of our plaintiff clients are requesting MSAs (whether or not they submit them to CMS) in order to “account for Medicare's interests” in these cases. I think to not have an MSA, especially in a high dollar liability case with significant future medical needs, is a risky proposition.
I certainly agree. After the AAJ made their statement, most liability cases that I was on opted not to do anything. While it is clear that an MSA is not NECESSARY, protecting Medicare’s interest as per the Medicare as Secondary Payor act IS NECESSARY.