Medicare, Medicaid & Healthcare Compliance
Medicare Secondary Payer Act (MSP) issues a broad mandate that Medicare shall be a secondary payer and that all primary payers must take Medicare’s interest into account when settling a workers’ compensation or liability case; however, there is confusion, conflicting case law and, in some areas, a complete lack of guidance in terms of how primary payers should comply with the MSP general mandates. While CMS has issued some guidance through a series of memoranda and calls over the course of time, many issues surrounding compliance with the MSP (particularly with respect to liability cases) remain unclear.
Accordingly, we recommend that just like corporations who devise their own compliance plans in order to adhere to the FCPA, Law Firms and their clients subject to the MSP ought to utilize a wide range of tools/services on a consistent basis and in accordance with a documented compliance plan in order to protect Medicare’s interest and protect themselves.
We at ESS understand that law firms, insurance carriers, self-insured’s and third party administrators are under enormous pressure to comply with the MSP. Regardless of whether your organization has an MSP compliance plan in place, you and your clients will likely benefit from one or more of our services when settling a personal injury case.