Misconceptions about Liability MSA’s

Liability Medicare set-asides are defined as money taken from a liability or automobile accident settlement that can be used to pay future medical and prescription drug payments. These payments are allocated in order to prevent these charges from being reimbursable to Medicare. LMSA’s are often a source of confusion for many people. This is due in part to a lack of clarity on how they should be carried out. Unlike Workers’ Compensation Set-Asides, for which the Centers for Medicare and Medicaid Services (CMS) has provided a reference guide, policies on liability MSA’s are more vague. This can cause a great deal confusion for attorneys and their clients.

To provide clarity, we will tackle a couple of common misconceptions about set-asides, including those related to liability settlements.

False: Liability Settlements Don’t Need to Consider Medicare’s Interests as Workers’ Compensation Settlements Do

While there are more establish guidelines for worker’ compensation settlements and set-asides, it doesn’t mean that Medicare’s interests don’t have to be considered in liability cases. According to 42 U.S.C. §1395y(b)(2)(A)(ii), when a workers’ compensation plan, liability or automobile insurance, or no-fault insurance is in place, Medicare is not to make medical payments. With that said, it’s vital to keep Medicare’s interests in mind in these situations.

False: MSA’s Should be Used to Reimburse Conditional Medicare Payments Before a Settlement is in Place

MSA’s including LMSA’s should only be used after the settlement is in place. MSA’s are meant to be used to take the cost of future medical expenses away from Medicare after a settlement.

For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.

Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.

TESTIMONIALS

"I recently engaged Synergy to assist with a complicated PTD settlement involving a substantial Medicare Set Aside. The claimant’s wife has been providing full time attendant care which is not Medicare covered. The Synergy nurse was able to do a full analysis of non-Medicare covered expenses which far exceeded the value of the MSA analysis performed by the carrier’s contracted MSA provider. The non- Medicare figures became the main focus of the settlement negotiations and more than doubled the value of the case. Although I could estimate the attendant care figures, the nurse added in other items that I would not have routinely considered. I also asked Synergy to evaluate the EC’s MSA as well as their prescription review. Synergy offered insight about the prescription donut hole which I did not have a clear understanding about. Again, their insight and information added a great deal of value to the overall settlement. Not only did I learn from Synergy but was able to educate my clients in the process. These are very complex and complicated areas; I will use Synergy again and again!"

Rosemary Eure
Lancaster & Eure

“Synergy is our guiding light for deferring our contingent legal fees and planning for retirement. The lawyers at Panter Panter & Sampedro, myself included, have been working with them for over ten years using different methods to defer comp and plan for retirement.”

Brett Panter
Panter, Panter & Sampedro

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