Medicare Compliance for Plaintiff Attorneys

The federal government enacted the Medicare Secondary Payer Act in 1980. Since then, it has gone from a toothless idea to recoup money, to a convoluted beast affecting past and future medical payments in all settlements. What areas of the law are most concerning?


  1. Medicare Conditional Payments. Essentially, a “Conditional Payment Letter” from Medicare is equivalent to what you think of as a Medicare Lien. Did you know that Medicare can claim its lien from multiple parties? Both plaintiff and defense should have their own, separate Medicare Case IDs from which Medicare will try to collect. Medicare’s collection timing adjusts depending on case status, but, at various points of litigation it is possible for Medicare to claim a lien from all parties.
  2. Medicare Set-Asides. The idea of an MSA is not law, but rather, it is a tool to help Medicare comply with the Medicare Secondary Payer Act. That law says that Medicare may not pay for case-related treatment. Medicare pushes that burden to plaintiffs by telling them to prepare for Medicare to deny such treatment. And Medicare says it will grant plaintiffs what amounts to safe harbor if they follow Medicare’s guidance (and if Medicare approves the MSA).


Best practices for Medicare liens are easy: go through the Medicare process. For MSAs, there are too many factors to list and an agency (CMS) that refuses to review some MSAs. Best practices for MSAs generally consider risk. If there is a lot of expected future medical treatment an MSA is a good protection. If there isn’t much expected future medical treatment and the case settles for a lower amount, the practical considerations are less risky. 


Join us at the WILG 2022 Annual Convention at 2:15 p.m. (MST) on Friday, September 30. Ryan Weiner, Esq., MASSIVE’s COO and experienced lien resolution attorney, will join industry experts to discuss Medical Liens, Medicare Set-Asides (MSAs), and Administration, along with a Q&A session.


Be sure to register for the convention to join us for this in-depth discussion!