Medicare Matters: Part III --- Utilizing Medicare Set Aside Accounts

"Medicare Matters" is must-reading for anyone dealing with the settlement of personal injury or workers' compensation cases. Jill Schroeder and Stephanie Stacy have published the third and final installment of their readable series in the Nebraska Lawyer. This one addresses the use of Medicare Set Aside accounts (MSAs).

Medicare has the right to recover not only past conditional payments for accident related care, but also future payments. With the increased vigilance of Medicare in collecting these future amounts, the MSA has become the recommended vehicle to protect the payment of these costs by placing a portion of settlement proceeds in a designated bank account.

Properly utilized MSA's reduce or eliminate the liability of claimants, attorneys and insurance carriers for future conditional payments, thus ensuring that future Medicare benefits are not jeopardized and allowing significant claims to be settled.

Jill and Stacie are members of the Baylor Evnen law firm in Lincoln, Nebraska. We owe them our gratitude for enlightening those like me who are only occasionally  exposed to Medicare issues.

Medicare Matters: Parts I, II & III can all be accessed on my website.

Health Care and Medicare in McAllen, Texas

With a per capita income of twelve thousand dollars McAllen and Hidalgo County, Texas constitute one of the nation's poorest regions. However, it has one of the highest levels of Medicare spending per person. Only Miami spends more. At fifteen thousand dollars per enrollee, the annual spending is three thousand dollars per year more than its per capita income. Why? Is there more disease because of the poverty? Are medical services better? Despite the 2003 Texas tort reform, could the threat of malpractice be forcing unnecessary testing? What is causing costs to skyrocket in this unlikely location?

The New Yorker magazine examines these issues and makes some startling observations in "The Cost Conundrum, What a Texas town can teach us about health care."  Among them: "[t]he primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine."

If you are interested in Medicare costs and the national health care debate, this will be good weekend reading. Also, take a look at the NYTimes article,  Health Care Spending Disparities Stir a Fight, for congressional/political responses to the New Yorker article and the geographical disparity data gathered by Dartmouth Medical School.

Enjoy!

Medicare Matters, Part II

When dealing with injury claims, what you think you know about Medicare issues is probably economically riskier than what you don't know.

In the latest of their series on the impact of Medicare on injury claims, Stephanie Stacy and Jill Schroeder, members of the Baylor Evnen law firm in Lincoln, Nebraska, discuss the persistent myths surrounding Medicare's right to recover conditional payments from the proceeds of personal injury and workers' compensation recoveries.

Congress has given Medicare sweeping authority to recover their payment of past and future medical costs from a Medicare beneficiary's settlement proceeds. If Medicare determines that its interest has been circumvented, no one is safe. The beneficiary, his lawyer, and the insurance company will each be accountable for the reimbursable amounts.

The article discusses Medicare myths that have developed as frustrated lawyers struggled to find effective strategies for settling injury claims involving Medicare and looked for efficient workarounds to avoid the lengthy delays inherent in the MSP bureaucracy.

Prior articles:
Medicare Matters, Part I

Medicare Waiting Period: Reform Legislation

Sen. Jeff Bingaman (D-NM), and Rep. Gene Green (D-TX) have each introduced bills in Congress to phase out the Medicare waiting period for "life-threatening conditions." These are not delineated in the bills, but defined as conditions that are "fatal without medical treatment." The Secretary of Health and Humans Services would be responsible for compiling a list of such conditions, with regular updates.

Medicare Matters, Part I

Medicare really matters, and for injury-claim-handlers, now more than ever. We regularly deal with the complex world of medicare set-aside trusts, the MSPA of the MMA, but now get ready for the MMSEA (the Medicare, Medicaid, and SCHIP Extension Act of 2007). This Act contains mandatory insurer reporting requirements for payments made to injured workers eligible to receive benefits; and, if I still need to get your attention, civil penalties for failure to report of up to $1,000 per day per claim.

Due to the newness and complexity of the issues, I personally have avoided trying to learn the rules and terminology. How about you?

But help is on the way! I was delighted to find a helpful article published in March, 2009, edition of the Nebraska Lawyer. Medicare Matters covers issues arising from Medicare's right to recover conditional payments. Part I of the series addresses the new mandatory reporting requirements. Part II and III will deal with recovery of past conditional payments and set-aside trusts.

Stephanie Stacy and Jill Schroeder, members of the Baylor Evnen law firm in Lincoln, Nebraska, have explained the issues in terms that even a judge can understand. You can read and print this article on my website, by clicking here.