Leave a comment

NJ Court: Federal Law Does NOT Mandate Medicare Set-Asides

The United States District Court of New Jersey recently stated (albeit in an Unpublished Opinion) that Federal Law does not mandate Medicare Set-Asides in a liability context.  The question arose in Sipler v. Trans. Am. Trucking Inc. following a general settlement for $225,000.  After the verbal settlement the defense attorney attempted to insert language stating:

  1. The plaintiff cannot claim reimbursement from Medicare for healthcare arising out of the sued-for claim;
  2. His health insurance will not pay for healthcare arising out of the sued-for claim because those injuries are pre-existing; and,
  3. Medicare will not pay for future treatment and healthcare arising out of the sued-for claim.

The defendant’s first argument requiring a Liability Medicare Set-Aside comes from CMS’s September 2011 Memorandum where it stated, “[a]ll parties do have significant responsibilities under the MSP to protect Medicare’s interests when resolving cases that [include] future medical expenses. A recommended method to protect Medicare’s interest is a set-aside arrangement…”  (Emphasis in Original).  The court noted, “however, it is well-settled that ‘[i]nterpretations such as those in opinion letters-like interpretations contained in policy statements, agency manuals, and enforcement guidelines … lack the force of law…’ ” Citing Christensen v. Harris County, 529 US 576, 587 (2000).

Next, the court very clearly stated what would eventually become its holding:

Indeed, no federal law requires set-aside arrangements in personal injury settlements for future medical expenses.

What makes this decision most interesting is that it came after the Federal Register’s Advanced Notice for Proposed Rulemaking regarding Liability Medicare Set-Asides (LMSAs).  In the end, the Court enforced settlement without the three terms discussed above.  But our main takeaway from this case is the Court specifically stating there are no federal laws requiring LMSAs.

At Lien Resolution Services we can assist you with Medicare lien resolution, Medicaid lien resolution, ERISA liens, private insurance liens, and more.  We’ll take care of getting you the “lien” and reducing it too.

Ryan J. Weiner
Lien Resolution Services
This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.

About Ryan J. Weiner

Co-Founder of Lien Resolution Services, LLC, a national healthcare lien resolution firm. Our goal is to assist in the fair administration and resolution of healthcare liens on personal injury cases. Please visit our website for more information: www.lienresolutionusa.com.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: