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MEDICARE SET-ASIDE (MSA) ARRANGEMENTS & ALLOCATIONS: WORKERS' COMPENSATION (WC)

Medicare Secondary Payer (MSP) Act Requirements

• MSP Act Statute - 42 U.S.C. 1395y(b)(2)
  

• MSP Regulations - 42 C.F.R. 411, et seq. (Medicare has 2 year from date of discovery to demand and 3 years to recover)
  

Medicare Rights of Recovery (ROR)

• Have priority over all other private, statutory, or government liens and claims
  

• Triggered when payment is made
  

Penalties

• Initial demand via letter (do not ignore)
  

• Double damages plus interest
  

• Prosecution by Department of Justice
  

MSA Allocations Consist of:

• Medical records review
  

• Medical claims and pharmacy payment history review
  

• Physician recommendations
  

• Standard of care
  

• Manufacturer replacement recommendation
  

MSA Arrangements Consist of:

• MSA allocation amount
  

• Method of MSA funding
  

• Method of MSA administration
  

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MEDICARE SET-ASIDE ARRANGEMENTS & ALLOCATIONS

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This page was last updated: March 6, 2012

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