Medicare Setasides Set Attendees' Mood Ablaze

Medicare Setasides Set Attendees' Mood Ablaze | Risk & Insurance Medicare setasides is a complicated subject, getting more complicated. The attorney who helped to craft how the process works answers any and all questions about it at the NWCDC.

By MATTHEW BRODSKY, senior editor/Web editor

Jim Pocious played "stump the chump" during Thursday's NWCDC session titled "Medicare Setasides; What Are Your Questions." And being that the attorney from Marshall, Dennehey, Warner, Coleman & Goggin helped to craft the current Medicare setaside system with the government, Pocius proved a hard "chump" to stump.

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And it wasn't for lack of questions. The topic of Medicare setasides--whereby employers and insurers can end up "setting aside" a certain amount of cash so that Medicare doesn't foot the bill for healthcare costs for injured workers (until that setaside is depleted)--made attendees noticeably angry, confused, irritated, worried.

Understandably so. Starting May 1, the government will have the power to go back as far as it wants to examine cases in which they think it's due medical expenses.

As Pocius told the audience members, expect to receive a letter from Medicare that says, "We think you owe us money."

Medicare will also then have the power to know all liability settlements, as carriers will have to start reporting them.

"Yeah, they were serious when they passed it," said Pocius.

Pocius managed to answer all questions and chill the attendees' emotions (at least for the time the attendees were in the session). But he also soothed by providing practical advice for dealing with the confusing system.

First off, that letter from Medicare: Employers can contest that claim. Pocius said you should.

His other primary piece of advice. Settle as many cases as you can between now and May 1. Medicare will not dig around settled cases looking for setasides.

Pocius also advised to add into settlement language that Medicare's interests have been taken into account, even if the case does not deserve a setaside consideration. If a case could qualify for a setaside, then send a letter to Medicare reporting that the case qualified.

In bigger qualifying cases--those perhaps in the million-dollar range--set up the necessary setaside and ask Medicare for a voluntary review on it.

"I would rather have them approve the number from the plaintiff's side to protect my client," he said. It's in the defense's interests to have this voluntary review too.

But as if the audience needed to be reminded to be angry, confused, irritated, and worried, Pocius said not to expect these reviews or protests to go quickly.

And don't expect the whole system to be cheap. When getting the law passed, Medicare expected the costs to business to be about $8 million.

"What do you think the odds are of that?" he wryly observed, adding that the black lung program was originally estimated by the government to cost $8 million.

"And now billions of dollars later...."

November 20, 2008

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