Synergy Blog

Medicare Looking to Stop Inappropriate Payments to Injury Victims? Department of Health and Human Services (HHS), Office of Inspector General’s Work Plan 2013

By Jason D. Lazarus, J.D., LL.M., MSCC, CSSC

The Office of Inspector General for the Department of Health and Human Services recently released its 2013 Work Plan.  HHS oversees the agency charged with administering the Medicare program, CMS.  According to the document, “[t]he U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan for Fiscal Year 2013 (Work Plan) summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the next fiscal year (FY) and beyond.”  In the document, there is a brief blurb regarding the MSP and “Improper Medicare Payments for Beneficiaries with Other Insurance Coverage”.  Below is what was contained in the document.

Medicare as Secondary Payer—Improper Medicare Payments for Beneficiaries With Other Insurance Coverage

We will identify improper Medicare payments made for services to beneficiaries who have certain types of other insurance coverage to assess the effectiveness of Medicare’s controls to prevent such payments. (Social Security Act, § 1862(b).) We will determine whether selected non-Medicare health plans properly reported insurance coverage information to Medicare as required. (Medicare, Medicaid and SCHIP Extension Act of 2007, §111). (OAS; W-00-13-35317; various reviews; expected issue date: FY 2013; new start)

What is interesting about the foregoing is that it appears to address an issue that I have been talking about with plaintiff personal injury practitioners and injury victims alike.  The issue is that with mandatory insurer reporting now in full swing, Medicare can easily identify and deny future medical care post settlement.  The question becomes then what to do in light of this issue when a case is settled involving a Medicare beneficiaries with future medical needs covered by Medicare.  The simple answer is that some sort of a Medicare Set Aside analysis should be done to make sure that the issue is addressed appropriately.  That does not mean a forma set aside need be established, but it means that the issue must be investigated to determine what, if anything, should be done.

To view the entire report click HERE


"I just want to thank Synergy for their great work in getting a health insurance lien resolved. The health insurance company refused to reduce their lien a penny from a motorcycle accident involving my client who was not wearing a helmet, a fact that would have hurt our award in front of a jury. Synergy put tremendous pressure on this company, and after months of bombarding this insurance company with statutory requests and threats, they were able to get them to give in and reduce the lien significantly. The cost was minimal in relation to the hard work they put in, and the savings my client received. Client was very happy, and it allowed me to close out a case that I had resolved over 6 months before. Keep them in mind if you are dealing with a smug insurance adjuster who felt confident he would not have to reduce a lien, like I was dealing with. Thank you very much Synergy."

Jeffrey A. Adelman, Esq.
Adelman & Adelman, P.A.

When we face difficult post resolution issues, we turn to Synergy. They provide us with the necessary expert advice about Medicare compliance, preservation of public benefits, lien resolution and settlement planning. We don’t need to go anywhere else, they are the experts when it comes to the case after the case. All of those sticky issues, they easily navigate and let us focus on other issues.

Andrew Knopf
Knopf Bigger

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