My Conversation with Parashar B. Patel of the "Patel Memo"

Anyone who has been involved in workers’ compensation claims and Medicare Set Asides (MSAs) is likely familiar with the Patel Memo. The Patel Memo is the Centers for Medicare & Medicaid Services’ (CMS) first formalized policy memorandum relative to MSAs. While CMS has consolidated and supplanted all CMS memoranda within the Workers’ Compensation Medicare Set Aside (WCMSA) Reference Guide, the Patel Memo codified numerous foundational aspects of MSAs, many of which are still applicable nearly 20 years later. Issued on July 23, 2001, the Patel Memo established MSAs as the method to address Medicare’s interests in certain workers’ compensation settlements.

The Patel Memo instituted central concepts and the core framework we know today, including:

• Identifying regulatory authority under 42 CFR 411.46
• Distinguishing commutation and compromise workers’ compensation settlements
• Establishing authority to provide written opinion / review of the sufficiency of an MSA prior to an individual being entitled to Medicare
• Established formalized review thresholds (although the monetary thresholds eventually changed)
• Process for post-settlement monitoring
• Indication Medicare would not pay until there was a temporary depletion or permanent exhaustion of the MSA
• MSA to cover lifetime medicals (not for a limited time period)
• Directed payment at the applicable workers’ compensation fee schedule

As a student of MSAs for over a decade, I was lucky enough to make the acquaintance of Parashar B. Patel. I was able to sit down with Mr. Patel to discuss the memo, its background and impact, as well as his thoughts on the MSA industry. This conversation will be broadcasted in an upcoming educational webinar. You can register now for this exclusive event here.

Before meeting Mr. Patel, I had thought little of the person behind the memo. In talking with him, it was fascinating to learn about his background and get his thoughts on how the MSA industry has evolved since the issuance of the memo. Mr. Patel is a healthcare policy expert. He holds a Bachelor of Science and Master of Public Administration from the University of Connecticut. During his tenure at CMS, he spent nearly four years as Deputy Director of the Hospital & Ambulatory Policy Group (1999-2003). This group oversees payment policy for nearly all of Medicare’s acute care payment systems, including inpatient and outpatient services. During Parashar’s tenure, his group also had oversight of several other policy areas, including workers’ compensation.

Being humble, Mr. Patel was surprised the memoranda has come to bear his namesake. As with many things in large organizations, and certainly within a federal agency, many people take part in crafting something like a policy memo. Mr. Patel indicated that while the memo likely issued under his review and ultimate approval, there were other primary contributing authors and various Regional Offices who had a hand in its creation.  

Regardless, the Patel Memo has come to be known as the seminal document in the MSA industry. We’re thankful to Mr. Patel and the role he played within CMS at the time to help shape the policy that has largely remained to this day. To listen to a more in-depth discussion with Mr. Patel and the impact his memo has had, please join me in an upcoming webinar, which will air on Thursday, October 22, 2020 at 2:00 p.m. Eastern.

By Shawn Deane 

Shawn Deane is General Counsel and leads the legal team at Ametros. He has over a decade of experience practicing law and in Medicare Secondary Payer (MSP) compliance as an industry thought leader. He was previously Vice President of Medicare Compliance & Policy at ISO Claims Partners. Prior to that he practiced insurance defense litigation and healthcare law.

He has been heavily involved with the National Alliance of Medicare Set Aside Professionals (NAMSAP), having served as chair of the webinar and education committees, on the Board of Directors, and was past President in 2017. He was also former executive committee member with the Medicare Advocacy Recovery Coalition (MARC). Shawn is faculty for the Certified Medicare Secondary Payer Professional Program (CMSP).

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