Medicare eligible. It seems that when a defendant hears these words, CMS automatically places a target on your client’s back and aims for the bullseye. We have seen this happen year in and year out. That is why we crafted the ability to provide attorneys with holistic Medicare Set-Aside solutions.

The label of being “medicare eligible” can lead to many un-truths. For example, defendants may claim that your client must create an MSA. Un-true. And this one: that defendants won’t be able to settle your case until they have proof that Centers for Medicare and Medicaid Services (CMS) has approved your client’s MSA.  Un-true. Or, that you must obtain a CMS letter stating that an MSA is not required in your client’s case.  Un-true, and not even possible. If any of this sounds familiar, it’s because defendants have been telling you un-truths about Medicare Set-Aside (MSA) arrangements for years.

The truth is that there is no legal requirement for MSAs at all in liability personal injury cases. CMS is not approving liability MSAs. Also, CMS will not provide a letter stating that an MSA is not required in a specific case. In fact, MSAs are entirely voluntary. A conclusion that arose again as a result of the Aranki vs. Burwell case. Yet, this outcome doesn’t mean that MSAs should be ignored. No. Far from it. That is why we have tirelessly sought to provide Medicare Set-Aside solutions that address these untruths to help your client make an informed decision. Part of making an informed decision is knowing the history of MSAs, and understanding why MSAs should not be ignored.

The History Behind Medicare Set-Aside Solutions

The Aranki vs. Burwell case evolved from a medical malpractice case that started in 2009 in Arizona. While a settlement had been reached, the defendants were still concerned about its finality due to the uncertainty of the MSA question. A lot was unknown about MSAs back then, and the defendants thought they would be liable without a court decision on its necessity. They demanded that the plaintiffs supply them with a letter from CMS stating whether or not the client was required to set up an MSA. With no immediate answer, the settlement was held up for three years. That is, until a federal judge issued a pronouncement.

The judge stated that no federal law or CMS regulation requires the creation of an MSA in a personal injury settlement. It gets better. This judge was also asked to rule on forcing CMS to issue a letter as to whether or not this client needs an MSA. The ultimate finding being that there’s no federal law that requires it [CMS to issue a letter], so the court doesn’t see any standing here to even comment. No MSA required meant case closed, and this decision has acted as the ruling going forward. Yet, recent events indicate that a change could be coming soon.

Recent Developments

More critical insight is available in the 2011 Stalcup memo. A memo by Sally Stalcup, Regional Director of Region 6 for Medicare and CMS in Dallas. Her memo states that we must protect Medicare trust funds from payment for future service. Regardless of whether it’s Worker’s Comp. or liability. Surrounding language indicates that while CMS does not mandate a specific mechanism to protect those interests, and the law does not require a set-aside in any situation, that an MSA is the preferred method. Also of note is that any time plaintiffs can expect settlement funds to pay for future services, they can’t bill Medicare for future medical services until the exhaustion of these funds. Exact text is below:

After this memo, a clamor for guidance followed. With that, came an advance notice of proposed rulemaking. Issued on June 15, 2012. This advance notice, addressing liability cases, includes seven different options. All of them for handling the Liability Medicare Set-Aside issue. Especially alarming is option number four, below. It requires submitting a proposed MSA to CMS for review and approval.

Fast forward two years later to October 8, 2014. CMS withdrew The Project for Public Guidance. This advance notice was part of that project. Yet, expectations that CMS will resubmit at some point in the future still loom large. Added to these is another concern. Earlier, CMS published an update to a pre-solicitation for a workers compensation review contractor. It states that a Statement of Work (SOW) update will include the processing of Non-Group Health Plan (NGHP) Medicare Set-Aside arrangements. The anticipated award date? November 7, 2016.

All of these are signs that the U.S. Government has pivoted. Also, that they are looking once again at Medicare Set-Aside arrangements in liability personal injury cases.

What Comes Next?

Meanwhile, it’s important to decide whether, and which, Medicare Set-Aside solution is right for your client. That depends on their unique facts and circumstances. Also, whether they are a do-it-yourself or a do-it-for-you type. The law requires that we protect Medicare Trust Funds from payment for future services. That is true whether it is a Worker’s Compensation or Liability case. There is no distinction in the law. But how exactly will your client comply with the law? The old pick a number out of the air? Or a professional MSA Allocation Study? Then, next question, self-administer, or professionally administered?  If they go the do-it-yourself route, can you trust that they will follow through and put some amount of money from their settlement in some sort of account? And then what, just decide on their own which Medicare bills should be paid?

If and/or when Medicare comes around and questions how your client determined the amount of their account, demanding a detailed accounting of how they spent that money, how will your client answer? What if Medicare dislikes their answers, and decides to deny future benefits for a time? Will your client still be happy with the advice you gave them today? Whatever you do, don’t make these decisions alone. Take advantage of consultation services from The PLAINTIFF’S MSA AND LIEN SOLUTION.

Let Us Help

Order our 3 Ways to Avoid an LMSA Toolkit. Together, we can decide if one of these ways can work for you. And if your client can’t avoid an MSA and wants professional help? Then we’ll create a custom, strategically-minimized Medicare Set-Aside allocation. One brought down to the lowest possible, reasonable and defensible number. The end result? More settlement funds in your client’s pocket. Less potential for future liability for you.

The PLAINTIFF’S MSA AND LIEN SOLUTION is here for you. Please visit our website at plaintiffsmsa.com or call us with any questions at 888-672-7583.

The post The Truth About Medicare Set-Aside Solutions—How What You Don’t Know Could Hurt You appeared first on The PLAINTIFF'S MSA AND LIEN SOLUTION.

At PMLS our battle cry is ZERO IS THE HERO! Our focus is on making MSAs disappear.

We have three ways to avoid an MSA. When we can’t make an MSA disappear entirely, we work to see that it is MASSIVELY REDUCED. Specifically, to the lowest rock-bottom amount that is reasonable and defensible.

Here are just a couple stories about MSAs we have battled for our clients:

Making 93% of an MSA Disappear!

When “Free” Costs Almost a Quarter Million Dollars…

If you are ready to have us CONQUER your Medicare and lien problems and make them DISAPPEAR – call us at 888-MSA-PLTF or 888-672-7583.

The post Making MSAs Disappear appeared first on The PLAINTIFF'S MSA AND LIEN SOLUTION.

Making 93% of an MSA Disappear!

We recently assisted an attorney based out of the great state of New York with an MSA. In the process, saving the injury victim from having to put an unnecessary $294,611.75 into their Liability MSA. In other words, making 93% of an MSA disappear.

At PMLS our battle cry is ZERO IS THE HERO!

We have three ways to avoid an MSA. When we can’t make an MSA disappear entirely, we work to see that it is MASSIVELY REDUCED. Specifically, to the lowest rock-bottom amount that is reasonable and defensible.

Saving the Injury Victim $294,611.75

In the case above, the plaintiff’s injury occurred in an incident involving ice. We were able to reduce the MSA from $314,094.91 to $19,483.16, saving the injury victim $294,611.75.

That MSA became 93% smaller, and most of it disappeared.

If you are ready to have us CONQUER your Medicare and lien problems and make them DISAPPEAR – call us at 888-MSA-PLTF or 888-672-7583.

For more information about ZERO IS THE HERO, see this link here — plaintiffsmsa.com/zero-is-the-hero

THEN – Check out our Three Ways to Avoid an LMSA resource to learn even more about our innovative approach!

The post Making 93% of an MSA Disappear! appeared first on The PLAINTIFF'S MSA AND LIEN SOLUTION.

Before, I introduced you to our new approach and astounding innovation, “ZERO IS THE HERO.” I shared the staggering results of how we are making some MSAs disappear.

If you missed that announcement, catch it here: plaintiffsmsa.com/zero-is-the-hero

We have three proprietary ways to reduce an MSA to ZERO, and in the video below I let you in behind the scenes to tell you about ONE of the THREE WAYS: plaintiffsmsa.com/zero-hero-part-2-make-msas-disappear

This short video tells you about TWO MORE WAYS!

Jack Meligan, RSP, BCFE, MSCC, CMSP-F

Your Medicare Problem Solver

P.S. When you are ready for us to conquer your Medicare and lien problems, call us at ‪888-MSA-PLTF or 888-672-7583.

Next – Check out our Three Ways to Avoid an LMSA resource to learn even more about our innovative approach!

The post ZERO IS THE HERO Part 3 – More Tactics We Use to Make MSAs Disappear appeared first on The PLAINTIFF'S MSA AND LIEN SOLUTION.

Before, I introduced you to our astounding innovation, “ZERO IS THE HERO,” and I shared the staggering results we are getting when we make MSAs disappear.

We have three proprietary ways to reduce an MSA to ZERO, and in this video I let you in on ONE of the THREE WAYS we make MSAs disappear.

Jack Meligan, RSP, BCFE, MSCC, CMSP-F

Your Medicare Problem Solver

​P.S. When you are ready for us to conquer your Medicare and lien problems, call us at 888-MSA-PLTF or 888-672-7583.

For more information about ZERO IS THE HERO, see this link — plaintiffsmsa.com/zero-is-the-hero

Then – Check out our Three Ways to Avoid an LMSA resource to learn even more about our innovative approach!

The post ZERO IS THE HERO Part 2 – Make MSAs Disappear appeared first on The PLAINTIFF'S MSA AND LIEN SOLUTION.

We are upping our game again!

ZERO IS THE HERO! This has been our fervent battle cry here at PMLS.

My unwavering mission for the past 30 years has been to see that injury victims receive financial justice.

Our most recent tactic in that battle has been further developing, and then honing, our now-documented legal approach that has already resulted in many of our injured clients allocating exactly ZERO dollars from their settlements to a Liability MSA.

While this tactic does not apply to all case situations, it has worked on more than 50 percent of our cases and has saved millions of dollars in unnecessary and/or potentially overfunded LMSAs.

Here is the video where I introduced the astounding innovation we call “ZERO IS THE HERO!”

Jack Meligan, RSP, BCFE, MSCC, CMSP-F

Your Medicare Problem Solver

​P.S. When you are ready for us to conquer your Medicare and lien problems, call us at 888-MSA-PLTF or 888-672-7583.

Next – Check out ZERO IS THE HERO Part 2 – Make MSAs Disappear to discover ONE of the THREE WAYS we make MSAs disappear.

Then – Check out our Three Ways to Avoid an LMSA resource to learn even more about our innovative approach!

The post ZERO IS THE HERO appeared first on The PLAINTIFF'S MSA AND LIEN SOLUTION.

When you settle a case, do you deactivate ALL the Medicare landmines? Don’t be that lawyer who misses one and gets a call from a distraught client. Read The Truth About MSAs… by Jack Meligan, Your Medicare Problem Solver.

In this white paper, Jack Meligan lays out all the Medicare landmines YOU should know about, and how to deactivate them. Plus, he reveals the truth about MSAs, and why they may be the best protection for your client.

Download this Jack Meligan white paper HERE, or click on the image below —

Outsource your Medicare and conditional payments headaches to us. Call us at 888-MSA-PLTF or 888-672-7583.

Next – The law does NOT require MSAs. However, that fact completely MISSES the point. So why do an MSA? Watch this Jack Meligan video — Why Do An MSA? The 37-Year-Old Law You Don’t Know About

The post The Truth About MSAs appeared first on The PLAINTIFF'S MSA AND LIEN SOLUTION.

Getting something for free is an enticing incentive.

The word itself states that you are receiving something at no cost to you.

Yet, are you really? One of our recent clients found that free nearly cost him almost $250,000.

Here is his story … In March of 2013, G.M. had been mowing his elderly neighbor’s pasture as he often did for all of his neighbors. When he finished mowing that fine spring day, the neighbor brought out a couple of cold beverages to share. G.M. enjoyed the refreshment and some neighborly chatter, then said his goodbyes. He was heading back home when a massively distracted driver rear-ended him on a road outside of Damascus, Oregon, ejecting him from his tractor.

Phone records show that the distracted driver had been talking, texting and checking email literally nonstop while driving for over two hours from Central Oregon.

G.M. sustained multiple injuries. Most severe was a traumatic brain injury, leaving him with the permanent mentality of a five-year-old.

Yet, what almost happened next could have caused even more damage, but of the financial type.

You see, our competitors were targeting G.M. and his attorney with an offer of free administration for G.M.’s MSA. However, there was a catch. The competitor also wanted to be retained to prepare the critically important set-aside report.

Their dirty little secret? By tying the creation of the set-aside report to the offer of free administration, their administration services would be anything but free.

This competitor’s recommended “set-aside” allocation, to cover both G.M.’s lifetime Medicare-allowable expenses and their free administration, came in at $453,826.96. A ridiculous sum, as this amount would have grossly overfunded G.M.’s voluntary MSA.

Luckily, G.M. and his attorney came to The PLAINTIFF’S MSA & LIEN SOLUTION (PMLS) for a second opinion.

Our proprietary allocation methods reduced the competitor’s recommended MSA amount to $206,288, which included the lifetime cost of our “White Glove” Professional Administration Services, a savings of $247,538 to G.M.

On top of that huge savings, PMLS’ Lifetime “White Glove” Administration Services will go on to provide G.M. and his attorney with much more than our competitors could ever offer.

First, G.M. has immediate access to his own dedicated, personal administration tech for all MSA and Medicare issues.

Additionally, he has a “hotline” 800 number manned 24 hours, 365 days a year, for immediate, direct assistance with any other “Life Care” problems, enabling his attorneys to gently cut the “umbilical cord” and move on to serve the next injured person whose case needs attention.

These services and the nearly $250,000 in savings were a much better deal for G.M., and his attorney was very pleased.

“These folks really know what they are doing – saved one of my clients from potentially overfunding their voluntary Liability MSA to the tune of $247,538!”

—Neil Jackson, Neil Jackson & Partners, Portland, OR, Immediate Past President OTLA (Oregon Trial Lawyers Association)

We believe this is how it should always be.

DON’T fall victim to competitors’ claims of free administration.

Avoid their dirty tactics with The PLAINTIFF’S MSA AND LIEN SOLUTION.

We will reduce your client’s MSA allocation to the absolute lowest, reasonable and defensible amount, GUARANTEED, and save your clients massive amounts of dollars that can be used for more important needs.

Outsource your Medicare and conditional payments headaches to us. Call us today at 888-MSA-PLTF or 888-672-7583.

Why do an MSA when they are NOT required by law?

Click HERE to see Jack Meligan’s short video to get the answer —
plaintiffsmsa.com/why-do-an-msa

Visit our website at: plaintiffsmsa.com to discover how PMLS can solve your Medicare problems.

Jack Meligan

Your Medicare Problem Solver
And the PLAINTIFF’S MSA & LIEN SOLUTION Team

The post When Free Costs Almost a Quarter Million Dollars … appeared first on The PLAINTIFF'S MSA AND LIEN SOLUTION.

Jack Meligan is the founder of The PLAINTIFF’S MSA AND LIEN SOLUTION, and he teaches that there are 3 Medicare problems every trial attorney must solve for their Medicare clients.

#1 – THE MEDICARE CONDITIONAL PAYMENTS ISSUE

The FIRST of three Medicare problems trial attorneys must solve is the Medicare conditional payments issue. This is the “past medical” that Medicare wants repaid at the time of settlement, or just after.

Not only is there the very REAL threat of “double damages” for missing this with Medicare or a Medicare Advantage Plan (as Paris Blank trial lawyers discovered – plaintiffsmsa.com/can-firm-take-punch-mouth ), there’s more. NOT dealing with Medicare conditional payments in a timely manner can cause a huge time delay in getting defendants to pay over an agreed-upon settlement amount.

The hold up? Most defendants are demanding to see a copy of Medicare’s Final Conditional Payments Demand Letter BEFORE letting go of the settlement check. However, this is not easy to obtain. The process with Medicare can take 90 to 120 days—even longer. Thus, starting well in advance of a possible settlement date is imperative if you want to avoid disappointing your client, your bookkeeper, or your banker.

#2 THE QUESTION OF MSAs AND FUTURE MEDICARE LIABILITY

The SECOND of three Medicare problems trial lawyers must solve involves MSAs and future Medicare liability. MSAs are absolutely NOT required by law. However, that fact misses the bigger point. The bigger point is that the law making Medicare SECONDARY to all forms of insurance dates back to 1980. Almost 37 years. Consequently, ignorance of the law is no defense.

When Medicare is notified, or otherwise discovers, that your client has a settlement that includes compensation for future medical, Medicare is PRECLUDED from paying. Then, they will notify your client. When your client gets a letter from Medicare denying payment, and they have no money left from their settlement to pay with, who are they going to call? YOU.

Hence, advising your client on the reason for and against creating a voluntary minimalized MSA account, with or without professional administration, is imperative. Especially if you want to avoid having an uncomfortable phone call from your client sometime down the road.

#3 THE SECTION 111 SETTLEMENT REPORT

The THIRD of three Medicare problems trial lawyers must solve is the Section 111 Settlement Report. Medicare LEGALLY requires defendants to submit this report on the date of settlement, and it has 196 data points!! Now, not all of them are filled in on every report or any one report. The one that is CRITICALLY IMPORTANT to your client is the complete list of all the ICD-9 or 10 codes. These codes identify the treatments for your client’s injuries or conditions that are the subject of their settlement. The problem? This information goes into your client’s common working file at Medicare. Their job is to match these codes with future billings and DENY payment for bills that reference those same codes.

There have already been numerous instances where defendants have misreported or even negligently reported pre-existing conditions, OR EVEN SOME OTHER PLAINTIFF’S CONDITIONS, to Medicare. When this happens, your client can be erroneously denied payment from Medicare for those services. This can cause a lot of potential problems. Maybe even life threatening ones. Furthermore, it takes a trip to an ALJ to straighten out the mess.

Therefore, adding language to your Settlement Agreement and Release that PREVENTS or STRICTLY LIMITS the potential damage that a defendant’s negligent Section 111 Report to Medicare/CMS can cause, is imperative if you don’t want to have to fix one of these messes.

THE BOTTOM LINE

Do you want or need help with any, or all of these? The PLAINTIFF’S MSA AND LIEN SOLUTION has the answers. email us or give us a call. We are ready to help you.

Email — info@plaintiffsmsa.com Phone – 888-MSA-PLTF or 888-672-7583.

Protect your clients and save them money, as well as future hassles with Medicare. We will take all of these Medicare problems off of your desk, along with the hassle, worry and expense of compliance, so you can rediscover the joy of why you got into plaintiff’s trial law to begin with.

We are The PLAINTIFF’S MSA AND LIEN SOLUTION.

YOUR Medicare Problem Solver.

The post The 3 Medicare Problems Every Trial Attorney MUST Solve for Their Clients appeared first on The PLAINTIFF'S MSA AND LIEN SOLUTION.

Another case, another victory. This time, assisting an attorney from Alaska with a Medicare Conditional Payment (MCP) case. The result? A savings of $38,947.48 for the injury victim. Making almost half of the injury victim’s MCP disappear!

At PMLS, we believe ZERO IS THE HERO! Thus, our goal is making all liens disappear. When we can’t make them disappear entirely, we MASSIVELY REDUCE them to the lowest rock-bottom amount that is reasonable and defensible.

Saving the Injury Victim $38,947.48

In the case above, the plaintiff’s injury came from a slip and fall incident at a restaurant. We were able to reduce the MCP from $79,122.28 to $40,159.62, saving the injury victim $38,947.48.

That MCP became 49% smaller, meaning it was nearly cut in half!

If you are ready to have us CONQUER your Medicare and lien problems and also make them DISAPPEAR – call us at 888-MSA-PLTF or 888-672-7583.

For more information about ZERO IS THE HERO, see this link here — plaintiffsmsa.com/zero-is-the-hero

The post Making Almost Half of an MCP Disappear! appeared first on The PLAINTIFF'S MSA AND LIEN SOLUTION.