New Legislation Reinforces The Need For Medicare Set-Asides In Bodily Injury Liability Claims


Group Health Plans And Liability Insurers To Be Held Responsible

Tampa, FL  (CompNewsNetwork) - PMSI MSA Services, a unit of the nation's largest provider of pharmacy and specialty products and services for workers' compensation, commented today that through new legislation, Congress has reinforced the need to consider Medicare in all bodily injury liability cases.     

On December 29, 2007, the President signed into law the Medicare, Medicaid and SCHIP Extension Act of 2007. Section 111 (f) stipulates that bodily injury liability, No-Fault, and workers' compensation insurance claims in which Medicare is the secondary payer must be reported to the Secretary of Health and Human Services. 

The Medicare Secondary Payer Act requires that Medicare's interests be taken into consideration in any and all bodily injury liability settlements in which another payer would be primary. In a settlement, sufficient funds must be allocated for Medicare-covered, injury-related treatment in order for the primary payer to be protected from future exposure.  This is done through a Medicare Set-Aside (MSA). While the Act has been in effect for some time, compliance has been limited - predominantly, only workers' compensation claims have included MSAs - until now.   

The new law provides that claims reporting is required for both group health plans and liability insurers. The legislative intent of the Medicare Secondary Payer Act is to protect Medicare from making payments that are the responsibility of the primary payer-including non-workers' compensation injuries.

"As a leader in this industry, it is critical that we provide the market with immediate understanding of the requirement and the consequences non-compliance can have on our customers' business," stated Henri Bersoux, Vice President and General Manager, PMSI MSA Services. 

On July 1, 2009, insurers could face penalties of $1,000 per day per claimant whose Medicare status is not fully reported to the Government.  Also, Medicare has the option to terminate all benefits to a claimant if they are not protected as a secondary payer.

Bersoux continued, "PMSI has a sense of urgency regarding this law. It is our intent to help prevent the disastrous and costly impact it can have on all parties involved."

About PMSI

PMSI -The Only Solution You Need. PMSI is an integrated specialty service provider for workers' compensation and Medicare Set Asides. Founded in 1976, today PMSI provides a full line of MSA services for all bodily injury claims and is the nation's largest full-service network provider of workers' compensation-specific pharmacy, medical services and equipment, and clinical services.  PMSI promotes quality care for injured parties while helping clients contain costs and control utilization. PMSI is a subsidiary of AmerisourceBergen Corporation-a Top 50 company in the Fortune 500 list and among the Top 5 in the Pharmaceutical Service Providers category.

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