LMSA – Liability Medicare Set Aside

Medicare Set Aside and Liability Cases: Is it a Requirement?

Unlike workers’ compensation cases, Centers for Medicare and Medicaid Services (CMS) has issued no formal statutes, regulations, or guidelines concerning liability settlements. However, attorneys and their clients must be certain they are still placing a priority on protecting the interests of Medicare.

LMSA Memorandums Attorneys Should Know About

Following is a brief synopsis of two memos attorneys should familiarize themselves with that address Medicare set asides (MSA) and liability settlements.

The Stalcup Memo:

The memo is from Sally Stalcup, the MSP Regional Coordinator for CMS. Although a MSA is not required by law in liability settlement cases involving a Medicare beneficiary, Medicare’s interests should always be protected. It is expected that if a Medicare beneficiary is awarded in a case, those funds should be used towards medical services and exhausted before Medicare will step in. It is left up to attorneys to decide, per case, if there is future funding for medical services and a need to protect Medicare’s interests.

The CMS HQ Memo:

The memo from CMS Baltimore office states that a LMSA isn’t necessary if the Medicare beneficiary’s physician certifies in writing that all injury-related medical services to the claimed injury have been completed as of the date of the settlement. Any additional treatments made thereafter would need a written certification in the same manner. The physician’s certification would make getting a formal review from the CMS office unnecessary.

The Role of CMS

The CMS regional offices will review LMSAs on a case-by-case basis. Some offices may review them and some may not since there is no mandated law for liability MSA. Regardless of whether a LMSA is reviewed or approved, attorneys and clients must be must be certain that Medicare is always treated as a secondary payer to any other entity responsible for payment of medical items and services related to the liability settlement.

How Synergy Settlement Solutions Helps You

You have helped your client, now let Synergy Settlement Solutions help you. We know that an LMSA can become complicated without proper knowledge. However, we understand the complexities of Medicare laws and how they affect Medicare beneficiaries. To make your job easier, we offer an array of services including MSA analysis, allocation, and administration. Regardless of whether CMS reviews a liability MSA or not, we want you to be confident that your client maintains their Medicare eligibility and that you both remain Medicare compliant.

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 just wanted to say thanks to you and the entire Synergy Settlement Services team for helping us put together a series of structured settlements and special needs trusts in two complex cases involving significant recoveries. As always, your accessibility, guidance and expertise on a whole host of post-settlement issues is very much appreciated and valued, particularly with respect to the often confusing topic of Medicare set asides. I look forward to our continued collaboration on cases in the future and am very appreciate of the first rate service your company continues to provide to our clients."

Stephan Le Clainche
Formerly of Babbitt, Johnson, Osborne & Le Clainche

Synergy’s team makes it easy to deal with all of the issues we hate at the end of the case. Dealing with Medicare, ERISA liens, keeping eligibility intact for Medicaid and complicated planning for the client’s recovery. The experts we work with regularly at Synergy do a great job of making sure I am protected as are my clients.

J. Clancey Bounds
Bounds Law Group

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