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The Truth About Medicare Set-Aside Solutions – How What You Don’t Know Could Hurt You
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 best MSA is no MSA. That’s where we came in. Helping the attorney achieve a dramatic reduction of $200K, and ultimately a No MSA Legal Opinion.
But how did that happen? $200K to $0?
Joe Friday from Dragnet was known for his insistence on “Just the facts.” So, let’s start there.
The Claimant: A man hit by air ducting in an airport.
The Injuries: He sustained head, neck and shoulder injuries.
The Problem? This client needed guidance in a case where the MSA issue needed to be addressed, and there just weren’t enough funds to go around.
That’s where we were called in.
Here’s what happened:
This case is a great example of the results that we can achieve for your client.
The best MSA is no MSA, and we truly believe that.
However, if that is not possible, we’ll reduce your client’s MSA to the lowest, rock-bottom amount that is reasonable and defensible.
If these are the type of results you want for your client, shoot us an email at info@plaintiffsmsa.com or give Jack Meligan a call at 888-MSA-PLTF (888-672-7583).
See you again soon,
Jack Meligan, RSP, MSCC, CMSP-F
The Plaintiff’s MSA & Lien Solution
From Jack’s Desk: PMLS Video #44
Medicare & Dental Work – Teeth Are a Luxury
Jack Meligan had a plaintiff attorney reach out to him asking for some insight about helping an injury victim who needed some dental work done.
2020’s Medicare open enrollment deadline is December 7th, 2019. In this video, Jack shares Medicare’s position on dental work. He also gives you a work-around, should you ever find yourself working with an injury victim who needs dental work.
Medicare is Pivoting and Change is Coming
Make sure that you and your firm are ready.
Avoiding MSAs – At PMLS we have created tools and resources to help plaintiff attorneys avoid MSAs:
THE INSIDER’S GUIDE TO AVOIDING MSAs – If you would like to download our free resource – “THE INSIDER’S GUIDE TO AVOIDING MSAs”– see this link: http://www.avoidingmsas.com
THE 3 WAYS TO AVOID AN LMSA TOOLKIT – If you would like to purchase “THE 3 WAYS TO AVOID AN LMSA TOOLKIT,” see this link: https://plaintiffsmsa.com/order-the-three-ways-to-avoid-an-lmsa-toolkit/?page=toolkit
If you are ready to have the THE PLAINTIFF’S MSA & LIEN SOLUTION help you CONQUER your and possibly make them DISAPPEAR or get significantly reduced, then go to our website plaintiffsmsa.com. Or, call us at 888-MSA-PLTF (888-672-7583) for a no charge, no obligation initial consult.
Also, check out our “Attorneys Sued Over Medicare Issues” resource: www.AttorneysSuedOverMedicareIssues.com
P.S. “I have known and worked with Meligan and his firm for almost 20 years. They know this stuff. These folks are easy to work with, and you are likely to learn something that makes your life easier.”
— Rick H. Friedman, Friedman | Rubin, Seattle, WA
From Jack’s Desk: PMLS Video #42 DOJ Escalates the Targeting of Trial Attorneys
Another big settlement reached between the DOJ and trial attorneys! This time, a Baltimore law firm has paid $91,406.98 to resolve allegations related to Medicare Conditional Payments.
The details of this case reveal that the DOJ has significantly upped the ante. They make it clear that entering into a joint agreement with co-counsel can make you an accessory to the violation of mishandling Medicare Conditional Payments. Jack has the news and analysis for you.
Medicare is Pivoting and Change is Coming
Make sure that you and your firm are ready.
Within the DOJ press release that Jack refers to in the video above are two salient quotes every trial attorney serving injury victims needs to be cognizant of:
“Plaintiffs’ attorneys cannot refer a case to or enter into a joint representation agreement with co-counsel and simply wash their hands clean of their obligations to reimburse Medicare for its conditional payments,”
“We intend to hold attorneys accountable for failing to make good on their obligations to repay Medicare for its conditional payments, regardless of whether they were the ones primarily handling the litigation for the plaintiff.”
Here is a link to that DOJ Press release so you can see it with your own eyes: https://www.justice.gov/usao-md/pr/baltimore-plaintiffs-law-firm-saiontz-kirk-pa-pays-united-states-over-90000-settle
We’ve told you before about other attorneys who have been sued over Medicare issues – see this link for more information: www.AttorneysSuedOverMedicareIssues.com
Don’t Let This Happen to You!
If you are ready to have the THE PLAINTIFF’S MSA & LIEN SOLUTION help you CONQUER your and possibly make them DISAPPEAR or get significantly reduced, then go to our website plaintiffsmsa.com. Or, call us at 888-MSA-PLTF (888-672-7583) for a no charge, no obligation initial consult.
P.S. “I have known and worked with Meligan and his firm for almost 20 years. They know this stuff. These folks are easy to work with, and you are likely to learn something that makes your life easier.”
— Rick H. Friedman, Friedman | Rubin, Seattle, WA
MSA Initial Consult Overview
Plaintiff attorneys often call us to talk about whether or not there are any Medicare issues they need to address. Specifically, so that their client’s potential case settlement is not hindered or slowed down. We call this the initial consult call.
In the video below, Jack Meligan, Founder of THE PLAINTIFF’S MSA AND LIEN SOLUTION, answers many of the questions covered during these initial consult calls.
If, after watching this video, you have any further questions related to the specific terms and conditions of your case – call us and let us help you avoid any Medicare issues that could hinder and slow down your settlement – 888-MSA-PLTF (888-672-7583).
Suspended & Disbarred
Some plaintiff attorneys still don’t think that Medicare issues can impact them. If that is you, you might want to watch this video – From Jack’s Desk #32: Medicare vs. Trial Lawyers – It’s Worse Than We Thought – Suspended & Disbarred —
You Can Subscribe to PMLS’ Medicare Issues Video Emails
In order to stay up to date on PMLS’ insightful perspectives and strategies about Medicare and lien issues, subscribe to our email newsletter at: plaintiffsmsa.com/subscribe-pmls-medicare-issues-video-email
When you are ready to set yourself free from Medicare issues, call us – 888-MSA-PLTF (888-672-7583).
From Jack’s Desk #37: Priceless Peace of Mind –
Medicare Conditional Payments Lien Resolution
In this video, Jack Meligan specifically shares how plaintiff attorneys serving injury victims can have Priceless Peace of Mind with regard to Medicare Conditional Payments lien resolution:
“THE LIENHOLDERS AREN’T OWED ANYTHING.”
At The PLAINTIFF’S MSA & LIEN SOLUTION, we are all about “ZERO IS THE HERO.” An innovative tactic we introduced to the industry.
We have also copped an attitude. We believe, “The lienholders are owed nothing”
Here is Jack’s video about PMLS’ lien resolution services—“The Lienholders Are Owed Nothing”:
PUT US TO WORK ON YOUR LIENS—
When you are ready to have us help you with a lien, click this link to download our service form: https://plaintiffsmsa.com/msa-lien-resolution-forms
If you want more information about how THE PLAINTIFF’S MSA & LIEN SOLUTION can help you CONQUER your Medicare and lien problems and possibly make them DISAPPEAR or get significantly reduced go to our PMLS website: plaintiffsmsa.com. Or, call us at 888-MSA-PLTF (888-672-7583). Also, check out our “Attorneys Sued Over Medicare Issues” resource here: www.AttorneysSuedOverMedicareIssues.com.
Since November 2017 we have been field testing “ZERO IS THE HERO” and the results are staggering…
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 3 Medicare Problems Every Trial Attorney MUST Solve for Their Clients
There are 3 Medicare problems every trial attorney MUST solve for their clients. Not doing so can have disastrous results. For example, the following:
Sued for double damages. Erroneously denied payment from Medicare. No money left to pay denied Medicare bills. Frequently, these are real results.
No one wants to see their clients face these issues. So, what are these problems and how do you solve them? Watch Jack Meligan’s video below:
Outsource your Medicare and conditional payments headaches to us. Call us at 888-MSA-PLTF or 888-672-7583.
The trial attorneys at Paris Blank were the first to be sued over Medicare conditional payments. Here is the story and what you can do to protect you and your firm.
The First Biggest Mistake Trial Attorneys Make with the Medicare Conditional Payments Process
The Medicare Conditional Payments process is more important than trial attorneys realize. Their first biggest mistake? One that can cost their clients everything.
Outsource your Medicare and conditional payments headaches to us. Call us at 888-MSA-PLTF or 888-672-7583.
Watch our next video here — Can You or Your Firm Take a Punch in the Mouth?
The First Trial Attorney to Take a Punch in the Mouth from Medicare – What He Wants You to Know
Jack Meligan, founder of The PLAINTIFF’S MSA AND LIEN SOLUTION, shares lessons from Paris Blank’s Keith Marcus, the first trial attorney to take a punch in the mouth from Medicare. He may be the first, but he won’t be the last. Medicare is becoming more aggressive. Here’s what Keith wants you to know:
Outsource your Medicare and conditional payments headaches to us. Call us at 888-MSA-PLTF or 888-672-7583.
Watch our next video here — Why Do An MSA When They Are NOT Required By Law?
Get in Touch
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Get in touch to discuss your needs regarding MSAs and your settlement.
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