Medicare Secondary Payer (MSP) in Third-Party Liability Cases

This program provides a comprehensive overview of the Medicare Secondary Payer (MSP) framework as it applies to third-party liability cases, including medical malpractice, slip and falls, automobile accidents and more. Attorneys representing plaintiffs & defendants as well as insurers and organizations who self-insure must understand how MSP obligations affect settlement strategies, conditional payment recovery, and reporting requirements.

Faculty will review the statutory and regulatory foundations of the MSP Act, outline the three core components of MSP compliance-conditional payments, mandatory insurer reporting, and Medicare Set-Asides-and discuss how each impacts case resolution. Attendees will gain practical guidance on identifying Medicare's interests, avoiding double damage exposure, and ensuring proper reimbursement to the Medicare Trust Funds. Real-world examples will help clarify the nuanced distinctions between workers' compensation and liability contexts and provide insight into current trends in CMS enforcement.

Learning Objectives:

1. Explain the key statutory and regulatory provisions governing Medicare's rights as a secondary payer under 42 U.S.C. § 1395y(b) and related regulations.
2. Identify and manage conditional payment obligations, including how and when to report, dispute, and reimburse Medicare to avoid penalties and double damages.
3. Understand mandatory insurer reporting (Section 111) requirements and the potential consequences of noncompliance for insurers and self-insured entities.
4. Evaluate when and how Medicare Set-Asides (MSAs) may be appropriate in liability cases, and recognize how current CMS guidance differs from workers' compensation cases.
5. Incorporate MSP compliance into settlement planning and documentation, ensuring that releases, payment structures, and reporting practices protect clients and align with federal requirements.