Our Lien Resolution Services (LRS) team provides compliance assistance for attorneys and adjusters. We will guide you through medical lien obligations (searches/disputes/appeals). and in the case of Medicare, future medical allocations or Medicare Set Asides (MSAs). The experienced LRS group is led by Roger Larue, J.D., M.B.A., who has assisted in medical lien and allocation matters for individual (single-event) cases and class action/mass torts. Mr. Larue has published several articles and is a concerned industry leader.
Lien Resolution Services
We put the pieces of the puzzle together
What are Medicare and Medicaid Secondary Payer Laws?
Congress passed a series of provisions in 1980 to deal with rising Medicare costs that established Medicare as a secondary payer to certain other primary insurance plans. These are known as the Medicare Secondary Payer Act. It is not, as one of the United States Courts of Appeal observed, “a model of clarity.” Yet, it does clearly provide that, “where there is some entity, other than Medicare, obligated to pay for an item or service, that entity shall pay first, and Medicare shall pay the excess.” The Centers for Medicare & Medicaid Service is constantly changing its interpretation of the U.S. Code of Federal Regulations, and in general, how to protect Medicare’s interest.
WHAT YOU SHOULD CONSIDER
As Defense
Defendants may be liable for up to three years, if the plaintiff doesn’t use his settlement funds in compliance with the MSP Act. Further, the MMSEA §111 reporting requirements will give CMS the ability of an immediate cross check if Medicare beneficiaries spend their allocated funds in violation of the MSP Act.
As Plaintiff
CMS has interpreted the MSP Act to require that funds must be used for medical expenses that are Medicare-allowable and related to the injury. Some courts have held that plaintiff’s attorneys are responsible for up to six years from the time they receive the judgment/settlement funds.
As Claimant
CMS has stated that the entire settlement amount could be at risk if an MSA (approved or not approved) is not properly administered.