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“Settle for More by Not Settling for Less Than Integrity!”

At Integrity Consulting, we can also handle your Medicare Set-Aside (MSA) allocation needs!

In 1980, Congress adopted the Medicare Second Payer Act (MSP). This was done in an attempt to cut down on the skyrocketing Medicare costs, and simply put; stated that Medicare would not be the primary payer if a person has any other insurance at all involved (such as automotive, employer insurance, worker's compensation, et. al.). In those cases, the insurance is the primary payer and Medicare becomes the secondary payer.

However, between 1991-1998, Medicare still paid out nearly forty billion dollars in worker's compensation cases where they were supposed to be the secondary payer.  Subsequently, Medicare now demands that their interests be taken into consideration when a settlement payoff includes monies for future medical costs. The money that is set aside for that injury is intended to pay for that injury's treatment and release Medicare from doing so. Medicare also claims the right to review and approve of the amount of money that is set-aside. If this is done properly, the set-aside amount takes care of treatment for the injury, while the client retains his full Medicare benefits for his other health issues.

*If Medicare's interests are not considered, then Medicare is entitled to take legal action  to recover the funds spent on medical care for that injury, as well as limit or negate your client's Medicare benefits in the future.

**There are two more important items to remember:

1)  One is that they are allowed to recover twice the amount they paid out, or DOUBLE DAMAGES.

2)  The second is that they can demand these double damages from anyone to whom funds were paid out of the settlement, and this includes the attorney.

The MSA report that we can provide for your case, is the detailed report that determines the pertinent future medical care for the injury and what is covered by Medicare. This is vital information for you to know as you manage your case to ensure that Medicare's interests have been taken into consideration, so that both you and your client avoid any negative consequences in the future.

While right now MSA's apply primarily to worker's compensation cases, it is expected that it will also apply to regular liability cases in the future. This is alerting some attorneys to have MSA's developed for their liability cases, as well.

At Integrity, we can handle the different steps of the MSA process with CMS (Center for Medicare and Medicaid Services) for you.  In addition to the report itself, we can handle the Medicare confirmation/lien verification, and the submission of the MSA to CMS.