Medicare/Medicaid Challenges in Personal Injury Claim Settlements

Personal injury counsel must consider Medicare and Medicaid requirements when settling claims. The primary concerns involve Medicare Secondary Payer (MSP) rights and the Medicare, Medicaid and SCHIP Extension Act (MMSEA). While counsel for both sides must be wary of these obligations, plaintiffs’ counsel face the added obligation to ensure that their clients’ future healthcare benefits will be preserved through the settlement.

These obligations are complex and constantly changing. Learning how to spot these obligations and how to take steps during settlement to ensure compliance is essential to minimize the risk of liability and preserving the claimant’s future healthcare benefits in Medicare/Medicaid.

Listen as our panel experienced in both litigation and Medicare/Medicaid matters explains these obligations for counsel negotiating personal injury settlements and provides practical strategies for dealing with Medicare/Medicaid in these cases.

1. Introduction
2. Medicaid obligations
   1. Satisfying Medicaid liens
   2. Medicaid reporting obligations?
   3. Preserving Medicaid eligibility post-settlement
3. Medicare Obligations
   1. Reporting requirements under Section 111
   2. Resolving Conditional Payments for past medicals
   3. Addressing Medicare Set-Aside (MSA) concerns for future medicals
4. Introducing Predictive Settlement Strategies
   1. Allocations “On the Merits”
   2. Use of Single Arbitrator Solution

The panel will review these and other noteworthy issues:

• Are the requirements for Medicaid the same as they are for Medicare?
• When does an MSA need to be considered?
• How a predictive settlement strategy can minimize your reimbursement footprint.