Medicare Secondary Payer Act - Protecting Medicare's Interest In Insurance Settlements

Pursuant to 42 USC Section 1395y(b)(2), commonly known as the Medicare Secondary Payer Act, Medicare may not make payment for medical benefits where payment has been made or can reasonably be expected to be made under a workers' compensation law or plan of the United States or a state, or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no fault insurance. By law, Medicare has a priority right of recovery from the primary payer as well as from parties in receipt of third-party payments, such as a beneficiary, provider, supplier, physician, attorney, state agency or private insurer (42 CFR 411.24(g)). Accordingly, it is essential that all parties to personal injury insurance settlements ensure that Medicare's interests are protected and therefore of the utmost importance for all attorneys, insurance company personnel and medical billing professionals to fully understand how and when the MSP applies in any given personal injury situation. Failure to meet your MSP obligations may have some very significant financial ramifications such as attorney personal liability as supported by the 3rd circuit decision in US v. Harris, or an insurer $1,000 per day per case fine for failure to perform MMSEA reporting.

You will benefit from an overview of all pertinent statutes and regulations, as well as CMS interpretation in its manuals and policies. We will address individual areas of law separately as to the manner in which the MSP applies in each. Most significantly, you will learn about workers' compensation settlements, as CMS is most actively monitoring them and has established policies with respect to addressing past and future medical expenses in the settlement of claims. Liability MSAs continue to be discussed only in theory as there continues to be no established CMS guidance as exists for workers' compensation settlement. However, given the upcoming MMSEA reporting requirements and its hefty noncompliance penalty, it has become a very big concern of all insurers. You gain valuable insight and a better understanding of Medicare's role in insurance claims settlement.

Medicare as Secondary Payer

• The Law
• The Regulations
• The Policy

Medicare Liens - The Past

• Conditional Payments
• Repayment Required by Statute
• Compromise of Conditional Payments
• Coordination of Benefits Contractor
• Medicare Secondary Payer Recovery Contractor

Medicare Set-Aside Allocations - The Future

• When Must Medicare Be Protected in a Settlement?
• CMS Procedures for Workers' Compensation Settlements
• MSAs in Liability Settlements
• Calculating a MSA
• Annuities - a CMS Approved Method of Funding MSAs at Present Value
• Post-Settlement MSA Administration

MMSAE Section 111 Mandatory Insurer Reporting

• Legislative History
• Implementation
• Theory on Intent and Future Impact
• Noncompliance Issues

Miscellaneous

• Ethical and Legal Considerations for Attorneys
• Legislative Activities
• Internet Resources

• CLE (Please check the "Detailed Credit Information" page for states that have already been approved)
• HRPD
• Additional credit may be available upon request. Contact Lorman at 866-352-9540 for further information.
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