Medicare Overview

Medicare must always be considered a secondary payer in all settlements of future medical expenses. Therefore, Medicare’s interests must be protected.

In addition to setting aside a portion of settlement dollars to cover future medical expenses, parties can be required to repay Medicare for payments already made by CMS to a provider or beneficiary which should have been covered under the policy or claim (Conditional Payments). Insurers are also required to electronically report all claims which involve Medicare beneficiaries on an ongoing basis.

Successfully navigating a course to settlement through the complexities of the Medicare mandate requires not only a firm grasp of the rules, but also the experience and expertise of a firm such as ANS Rehab Consulting in making the sound medical decisions needed to analyze, project and properly allocate future medical costs.

Substantial penalties can be incurred for failure to protect Medicare’s interests in any settlement. By not addressing the issue of Conditional Payments, the primary payer and other parties (including attorneys) are subject to severe consequences, including double damages, loss of Medicare benefits for the injured individual, and other potential actions from CMS. Responsible Reporting Entities (RRE’s) who fail to meet the Medicare reporting requirements are subject to fines of $1,000 per claim per day.

For more information on our Medicare-related services, please see the links below. For more information on Medical Cost Projections and Life Care Plans, which may be an important step in developing a MSA Allocation, please refer to their respective services pages.

Medicare Set Aside Allocations (MSA)              Conditional Payment Resolution
Mandatory Insurer Reporting             Medicare Consent Forms     
MSA Referral Form              Contact Us              Home