Synergy Blog

Medicare Looking to Stop Inappropriate Payments to Injury Victims? Department of Health and Human Services (HHS), Office of Inspector General’s Work Plan 2013

By Jason D. Lazarus, J.D., LL.M., MSCC, CSSC

The Office of Inspector General for the Department of Health and Human Services recently released its 2013 Work Plan.  HHS oversees the agency charged with administering the Medicare program, CMS.  According to the document, “[t]he U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan for Fiscal Year 2013 (Work Plan) summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the next fiscal year (FY) and beyond.”  In the document, there is a brief blurb regarding the MSP and “Improper Medicare Payments for Beneficiaries with Other Insurance Coverage”.  Below is what was contained in the document.

Medicare as Secondary Payer—Improper Medicare Payments for Beneficiaries With Other Insurance Coverage

We will identify improper Medicare payments made for services to beneficiaries who have certain types of other insurance coverage to assess the effectiveness of Medicare’s controls to prevent such payments. (Social Security Act, § 1862(b).) We will determine whether selected non-Medicare health plans properly reported insurance coverage information to Medicare as required. (Medicare, Medicaid and SCHIP Extension Act of 2007, §111). (OAS; W-00-13-35317; various reviews; expected issue date: FY 2013; new start)

What is interesting about the foregoing is that it appears to address an issue that I have been talking about with plaintiff personal injury practitioners and injury victims alike.  The issue is that with mandatory insurer reporting now in full swing, Medicare can easily identify and deny future medical care post settlement.  The question becomes then what to do in light of this issue when a case is settled involving a Medicare beneficiaries with future medical needs covered by Medicare.  The simple answer is that some sort of a Medicare Set Aside analysis should be done to make sure that the issue is addressed appropriately.  That does not mean a forma set aside need be established, but it means that the issue must be investigated to determine what, if anything, should be done.

To view the entire report click HERE

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