Daniel W. Hayes, J.D., M.S.C.C.
© 2015

Medicare Issues in Liability and Workers' Compensation Settlements by Daniel W. Hayes, J.D., M.S.C.C., was written to guide practitioners through their analysis of how to best consider Medicare's interests when resolving claims involving medical exposure. The book is presented from the perspective of an insurance defense attorney with over 18 years in practice, who is a certified Medicare Set-Aside consultant and actively prepares Medicare Set-Aside Arrangements (MSAs), provides opinion letters, verifies liens, and engages with the Centers for Medicare & Medicaid Services (CMS) to resolve liability and workers' compensation claims.

Topics addressed under the Medicare Secondary Payer (MSP) Act include:
Steps to verify and dispute Medicare conditional payment liens
Private causes of action to enforce reimbursement on behalf of Medicare
Potential MSP exposure under the False Claims Act
Determining if a set-aside allocation is “needed” in a settlement
Is it ever “required” to submit a settlement to CMS?
Proposed new rules for liability settlements
Recent and anticipated changes under the SMART Act
Suggested release language for both liability and workers' compensation settlements

Also included for easy reference are reprints of numerous United States government publications, including a compilation of CMS memoranda, with the most recent CMS workload review threshold criteria; CMS alerts, including those pertaining to liability MSAs; CMS reference guides, with the complete Workers' Compensation Medicare Set-Aside Arrangements (WCMSA) reference guide, self-administration toolkit, and a sample WCMSA submission; as well as the most up-to-date life tables and CFR provisions.

Summary of Contents:
Chapter 1: The Medicare Secondary Payer Act
Chapter 2: Conditional Payments
Chapter 3: Workers' Compensation Medicare Set-Aside Arrangements
Chapter 4: Liability Medicare Set-Aside Arrangements
Chapter 5: Section 111 Mandatory Reporting
Chapter 6: Sample Settlement Language
Exhibit 1: Statutory Authority
Exhibit 2: Code of Federal Regulations
Exhibit 3: CMS Alerts
Exhibit 4: CMS Memoranda
Exhibit 5: CMS Reference Guides
Exhibit 6: Life Table
Exhibit 7: Ethics Opinions
Table of Authorities