Physician Life Care Planning

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Medicare Set-Asides (MSA) Arrangements are analyses performed to ensure that legal settlements are administered in accordance with CMS regulations.

Excerpts from a PLCP Medicare Set-Aside Arrangement

An MSA should be performed in all cases in which injured individuals are current Medicare beneficiaries, or in cases in which they will become Medicare beneficiaries within 30 months of a settlement date.

The Medicare Secondary Payer (MSP) Act makes Medicare the secondary payer in "any case where care can be paid by any liability insurance policy." The MSP provides Medicare a statutory lien in the amount of the payments it made towards medical treatment prior to a settlement. When an individual receives a settlement, they must repay Medicare for all the costs that Medicare covered, or face potentially putative liability in the form of liens and fines.

Further, if an individual anticipates receiving medical treatment for an injury/illness after they receive a settlement, and they are either a Medicare beneficiary or reasonably expect to become a Medicare beneficiary within 30 months of a settlement date, then they must allocate a specified portion of the settlement to a Medicare Set-aside account. A Medicare Set-aside Arrangement determines the requisite value of the allocation.

Section 111 of the Mandatory Insurer Reporting Act requires insurers to report all personal injury settlements to Medicare. This reporting alerts the CMS to recoup funds for all medical costs it paid prior to any settlement, and to deny coverage of future costs until the MSA account has been exhausted.

In cases in which beneficiaries have as mismanaged settlement funds and/or cannot reimburse Medicare, the CMS has transferred liability to the beneficiaries' legal counsel by claiming negligence to counsel compliance with the Medicare Secondary Payer Act. (see U.S. v. Harris, and U.S. v. Stricker).

MSAs not only protect Medicare's interests; they protect claimants and their counsel from Medicare.

Our Medicare Set-Aside Arrangements Include:

  • MSA Allocation Summary
  • Social Security & Medicare Entitlement Assessment
  • Medical Record Review
  • Summary of Current Medical Status
  • Summary of Recovery Prognosis & Future Treatment Recommendations
  • Summary of Medicare Allowable Treatments
  • Pharmacological Review
  • Summary of Proposed Consideration of Medicare's Interests
  • Summary of Administration Options
  • Detailed MSA Adjusted Future Medical Cost Projections

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