Medicare's Muddle

As a legal nurse consultant one of my many jobs is determining Medicare's interest and developing allocation reports for Medicare Set Aside arrangements in workers' compensation cases. The complexity of Medicare rules and regulations have about as much attention grabbing appeal as listening to a lecture on cold fusion. Most people don't get it nor do they really want to.

This confusing as well as debatable topic continues to have even attorneys perplexed as some still have not fully grasped the concept of the Medicare Secondary Payer Act of 1980. So, how does a law that was passed in 1980 still get overlooked in 2010? The truth is enforcement of this law has been historically lax until recently. For a couple of decades attorneys were allowed to walk workers' compensation settlements through the court system without addressing Medicare's interest, leaving Medicare to pick up the tab for billions of dollars.

We all know how government "red tape" delays processing, so I guess it took the federal government a few decades to realize how much money they were actually losing in the maze of secondary payer mandates. As the Centers for Medicare and Medicaid (CMS) contrive to avert further losses, proactive enforcement has now become a multi-edged sword aimed at all parties involved in worker's compensation cases.

The federal government has now made it abundantly clear that the age-old expression, "That's not my job," will no longer be an acceptable excuse when addressing Medicare's interest. If Medicare's interest is not addressed in workers' compensation settlements the end result can be harsh penalties not only for the claimant, but for the attorneys, medical providers, insurer and employer as well.

With the obligation to protect Medicare's interest now firmly established as a contributory responsibility, the process of determining exactly what that interest is lies with those who enjoy the art of collective reasoning. For those who are new at this perpetual paper chase it's time to sit back and buckle up - it's going to be a long ride.


For more information on Medicare Secondary Payer issues or Medicare Set Aside visit my website: www.cook-legalnursing.com or test your Medicare Secondary Payer knowledge on my Hubpage now.