Alabama Workers' Comp Blawg

  • 27
  • Sep
  • 2011

Medicare Interests Considered Protected Despite Lack of CMS Review

Recently in a case in Arkansas dealing with the Longshore and Harbor Workers' Compensation Act, a Federal Court ruled that Medicare’s interests were considered and protected based on a Medicare Set-Aside (MSA) allocation despite the fact that the settlement was over the $25,000.00 threshold and the Center for Medicare and Medicaid Services (CMS) refused to review it.

Evidence before the court showed that the Medicare vendor who prepared the MSA had repeated conversations and correspondence with CMS representatives who decided not to review the MSA submission. However, the value of the settlement ($1,000,000.00) clearly exceeded the $25,000.00 threshold. The Court stated:

“It is apparent to the Court from the aforereferenced CMS correspondence and affidavit from attorney (for Medicare vendor) that regardless of the details and potential deficiencies in the original submission, that CMS has decided it will not, for whatever reason, review or reconsider the proposed MSA, which response or lack thereof potentially jeopardizes what otherwise appears to be a reasonable settlement in the best interests of Billy Smith to accept and complete.”

After further review of the evidence, the Court found that the parties had done all that was reasonable and prudent and within their ability and authority to do to protect Medicare's potential interest in the settlement. As such, despite the lack of CMS review of a settlement above the $25,000.00 threshold, the Court held that Medicare’s interests were protected.

Read the full opinion here: Smith v. JLH Marine Terminals Of Arkansas

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