Medicare and Set-Aside Services

We recognize that navigating the Medicare system can be complex. We communicate closely with our clients in both workers’ compensation and other liability actions to ensure compliance with Medicare's statutes and regulations. Our attorneys are experienced in analyzing the need for and preparation of Medicare Set-Asides (MSAs). We work to minimize set-aside funds while expeditiously achieving approval from the Centers for Medicare & Medicaid Services (CMS), where appropriate, and ultimately obtaining effective and intelligent case resolution.

We regularly assist self-insured employers, third party administrators, insurance carriers and other law firms in Set-Aside arrangements, including settlement negotiation, resolution of conditional payment issues, medical and prescription drug cost projections, crafting case specific settlement language and procurement of timely approval from the CMS. Your MSA will be prepared by lawyers, not case managers, who are better suited to protect your interests.

Our attorneys have relied on in-house MSA expertise in limiting Medicare exposures and expenditures since the institution of the Patel Memo in 2001. We have successfully secured zero value Set-Asides, reduced the value of the Set-Aside fund where an MSA is required and continue to counsel clients and other law firms on a regular basis as to the most cost effective Medicare compliant solutions available.

The reach of the Medicare Secondary Payer (MSP) statute into liability cases has yet to be determined. We advocate aggressive resolution of conditional payment issues. We can also provide advice and direction in complicated cases involving Medicare beneficiaries, Section 111, reporting obligations and the looming concerns pertaining to future medical benefits in the face of the MSP. Our lawyers are regularly called upon to counsel insurance industry professionals, employers and lawyers as to obligations and liabilities.

Our attorneys regularly monitor alerts, bulletins and the evolving standards published by the CMS to include the Medicare Secondary Payer statute and more recently the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). The MSP places affirmative obligations on all parties to the settlement process to protect the interests of Medicare as secondary payer. In December 2007, the MMSEA was signed into law and established a complex Mandatory Insurer Reporting (MIR) plan. These new reporting requirements will have a continuing impact on the settlement process in both workers’ compensation and liability cases. In addition to educating our clients on these new requirements, we work proactively to structure effective reporting compliance programs while also incorporating into all cases protective mechanisms to prevent and defend against future Medicare legal exposures.

Every claim situation is different, and Medicare’s impact on a claim does not begin at settlement. Cassiday Schade can help you protect against claims by Medicare while also expediting the settlement process.