Liability Medicare Set-Asides


Liability settlements, judgments or awards are subject to Medicare Secondary Payer (MSP) considerations. Not only are these claims reportable and involve Medicare conditional payment resolution obligations, but future medical treatment should be considered when resolving some cases.

While Medicare has not issued formal guidelines for Liability Medicare Set-Asides, Medicare expects protection of its statutory rights under the Medicare Secondary Payer (MSP) laws. It is recommended that payers consider Liability Medicare Set-Asides in cases involving a Medicare beneficiary that are resolving for a “substantial” dollar amount.

Liability Medicare Set-Asides fall within the purview of various CMS Regional Offices, and the workload is distributed by jurisdiction. Each of these Regional Offices practices different protocols regarding Medicare Set-Aside review. Some offices review allocations carefully for adequacy and sufficiency, not unlike WCMSA review. Other offices refuse any review whatsoever. Please check with your Gordon & Rees team to determine whether an MSA and/or submission is appropriate in your claim.