WATCH YOUR LANGUAGE! CRUSHING WORDS THAT CAN SPELL DISASTER FOR YOUR CLIENT’S FUTURE MEDICARE BENEFITS
It’s your worst nightmare. You thought you and the defendant were on the same page. That is, until you saw the settlement agreement. Taking a closer look, you realize you missed a very important block of language. Language that releases the defendant from all liability, even if what they report to Medicare about your client is incorrect. Incorrect information of any kind is a setback, but the worst would be incorrect ICD-9 or ICD-10 codes. Particularly the kind that correspond with your client’s preexisting conditions. And not those that are the subject of their settlement. That kind of error could trash your client’s future Medicare benefits. It may be too late now to affect your past cases. But, how can you stop this in the future?
Something’s got to change. However, defendants and their insurance companies aren’t likely to be that something. Especially, if past behavior is any indication. Who can forget their reactions after the Section 111 Medicare Secondary Payer law update? The updated section stated that the “responsible reporting entity” (aka: the defendant or the self-insured), which does not report a Medicare-eligible beneficiary’s liability settlement to Medicare is subject to $1,000 per day, per claimant penalty. Defendants grossly over-reacted. Telling you that Medicare Set-Aside Arrangements (MSAs) were required in liability cases, and that they wouldn’t settle your case until they had proof that Centers for Medicare and Medicaid Services (CMS) had approved an MSA. Not true. And how did they even get all of that out of the updated Section 111 law? Furthermore, how can you trust them now?
Why You Can’t Trust Defendants
A recent case of ours out of Orlando proves that you can’t. As you know, defendants want a lot of release language. They want your client to indemnify them, hold them harmless, and even defend them from Medicare. Worse yet, they’ll do anything to get what they want. That includes hiding critical language in the middle paragraph of a settlement agreement. As they did in this case. That hidden language is what you see below, in red:
Frightening, right? We caught this language upon document review and showed it to the plaintiff attorneys, who were outraged. Then, we managed to remove it from the settlement agreement and replace it with language of our own before it was too late. You, however, might not be so lucky. So what can you do about this MSA defendant release language? Enlist the help of the expert team at The PLAINTIFF’S MSA AND LIEN SOLUTION and use our recommended “Plaintiff Liability Medicare Set-Aside Defendant Release Language” template.
Plaintiffs should want their own language in the settlement agreement, which is exactly what this is and why you need it for your Medicare-eligible beneficiary. First, we’ll do an MSA analysis on your client’s future Medicare-allowable expenses and minimize it to the greatest extent possible. Then we’ll give you our proprietary language to insert into the settlement agreement. Language that acknowledges the defendant/self-insured’s duty to report and holds them to a report of only the ICD-9/10’s and prescription drugs that we’ve identified. Problem solved.
What you don’t know about MSA pitfalls can damage your client’s future Medicare benefits. Let us help you avoid them. Sign up for our free video training series: How to Avoid Stress, Reduce Risk and Save Money in Cases Involving Liability MSAs, Structured Settlements and Lien Resolutions.