CMS Guidance on WCMSA’s Section 4.3

We like to remind the legal industry that Medicare Set-Asides (“MSAs”) don’t exist under the law. They’re a very good idea considering the consequences to a claimant or plaintiff of not having an MSA.


Remember that CMS’s recent update to the WCMSA User Guide has a new section 4.3 with CMS warning us of the consequences of skipping MSAs (or of using unapproved MSA products like Non-Submit and “Evidence-Based” MSAs).  If a Medicare beneficiary settles his or her case without an MSA,  Medicare will deny treatment that it assumes is case-related. Even if that treatment is not related to the case. Not only will Medicare deny that treatment, but it will also continue to do so until the beneficiary is able to show the entire net settlement has been used to pay for medical treatment.


The MSA isn’t the only piece of this puzzle. Medicare requires annual attestations as to what the MSA paid for and how much is left in the MSA. Can your client handle the attestations process? What about administration of the MSA (literally, the proper use of funds for treatment)? MASSIVE doesn’t offer professional administration of MSAs. That said, after we prepare the MSA, we highly recommend using a professional administrator to properly handle the MSA.


Why? Improper administration is equivalent to not having an MSA.