Medicare Set Aside News - CMS Recently Announced a $300 Threshold on Liability Settlements

The Recently Announced $300 Threshold by Medicare on Liability Settlements imposes its rights of reimbursement and recovery.

Medicare Secondary Payer Recovery Contractor (MSPRC) announced on its website that they have now implemented a $300 threshold for certain liability insurance cases. This announcement represents the first time Medicare has imposed a threshold related to its rights of reimbursement/recovery under the Medicare Secondary Payer (MSP) Act (42 U.S.C. §1395 y(b)(2)). What does this mean?

If a Liability claim is settled for $300 or less and the case meets certain criteria situations noted below, Medicare will not recover from that type of settlement. The key areas Medicare will be focusing on are as follows.

1. The Liability Settlement is related to an alleged physical trauma-based incident, not an alleged exposure, ingestion, or implantation, and
2. The Claimant does not have any additional settlements related to the same allege incident, and
3. Medicare has not already issued their Final Demand Letter.

Please note, this threshold specifically excludes settlements where an insurer/self insurer is paying medical bills directly or on an ongoing basis. This threshold also does not apply if a demand letter was already issued on the case.