Two Common Myths About Medicare Set Asides

When settling a workers’ compensation claim in any state, carriers and self-insured employers often make one of two crucial errors based on two commonly accepted compliance myths. Most focus solely on $25,000 and $250,000, the two threshold markers for determining if the Centers for Medicare and Medicaid Services (CMS) approval is required (the former if the claimant is Medicare enrolled, the latter if the claimant is expected to be enrolled within 30 months of settlement). However, the real issue that both parties in a workers’ …

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Settlement with the U.S. Department of Justice on outstanding conditional Medicare payments is a stark reminder to look before you leap when settling a claim.

On June 18, 2018, the United States Department of Justice (DOJ) issued a press release regarding a settlement involving claims that a personal injury law firm failed to properly reimburse conditional medical payments to Medicare. This press release is a stern warning that Medicare is required, by statute, to seek reimbursement for conditional payments made as a secondary payer — and it will. See 42 U.S.C. Section 1395y (6).

Conditional payments are payments made by Medicare before a beneficiary has obtained settlement, judgement, award or …

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