Qualified Settlement Funds and Medicare Set Asides

Question: Do you recommend using a Qualified Settlement Fund while any MSA issues are being resolved? What about including provisions in a Supplemental Needs Trust to pay for either past or future bills?

Answer: Great question! We think using a Qualified Settlement Fund (‘QSF”) is a win/win solution for parties who are resolving claims with MSP reimbursement issues (conditional payments, Medicare Set Asides or both). By establishing a QSF, a separate stand-alone legal entity, the defendant or insurance carrier can pay into the QSF and then walk away with no further exposure on lien and future medicals issues. Instead, that liability is taken on by the QSF. With funds in the QSF, the plaintiff then has the ability to resolve lien issues post settlement as well as properly address MSA issues. However, with respect to a supplement or special needs trust, CMS guidance has advised in the past that funding that is not sufficient, in and of itself, to properly address MSP reimbursement issues. If you want more information about the benefits to all parties in utilizing a QSF when resolving claims with MSP issues, please contact us.


Update on Implementation of ICD-10 Codes for MMSEA Reporting

On April 1, 2014, President Obama signed H.R. 4302, the “Protecting Access to Medicare Act of 2014” which postpones the implementation of ICD-10 codes. Per Section 212 of the Act, the Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets. ICD-10 codes are being implemented to provide…


Friday FAQ: Medicare Part C Plan Liens

Question: If a medicare beneficiary opts out of traditional Medicare and uses a BCBS, Humana, AARP plan, and is in an accident and is not put on notice via the replacement plan, is our firm and the beneficiary required to notify the insurance plan of a possible lien/claim? Answer: It would appear that your question…


When Can a Plaintiff Attorney Take Fees on WCMSA?

On March 19, 2014, a Louisiana appellate court rendered judgment in Benoit v. MMR (2014 La. App. LEXIS 716). There, the issue before the court was whether plaintiff attorneys were entitled to collect fees on the seed money portion of the Workers’ Compensation Medicare set-aside Arrangement (“WCMSA”) as determined by the parties and approved by…


Friday FAQ: What if my client will not set funds aside for future medicals?

Question: I have a case that has settled for a small amount because the client needed the money to stave off a foreclosure (long story) According to treating doctor,the client will need future care, and she is Medicare eligible (SSD). I have advised my client that in consideration of Medicare’s interests, she should put some…