As a leader in the practice of workers' compensation law, McConnaughhay, Duffy, Coonrod, Pope and Weaver is one of the few law firms to face head on a recent addition to the various sub-issues within the field: the protection of Medicare's interests as a secondary payer. The enactment of tough enforcement provisions in federal law, including the imposition of double damages, make it imperative that Medicare's interests be addressed whenever a claim against an employer is settled. Consequently, a failure to protect Medicare's interests is also a failure to protect the interests of the employer and the insurance carrier. In keeping with its role as a full-service employment law firm, our staff includes attorneys experienced in the evaluation of Medicare issues and the preparation of Medicare Set-Aside proposals.
Our services in this area encompass many Medicare concerns with special attention to the existence of conditional payments by Medicare, the identification of affected claims according to the proper criteria, the assessment of appropriate set-aside arrangements, and the preparation and submission of detailed Medicare proposals. We also provide the necessary follow up with the Centers for Medicare and Medicaid Services to ensure that the interests of the employer and the insurance carrier are fully protected.
Specifically, our staff performs the following functions for our clients:
- Securing future medical estimates and up-to-date medical records, if necessary.
- Determination of amount to set-aside for Medicare covered items using medical estimates, past payment history and life expectancy issues.
- Determination of life expectancy.
- Determination regarding necessity of obtaining a rated age.
- Coordination of informational packet to be provided to Centers for Medicare and Medicaid Services (CMS).
- Preparation of Request for Approval of Set-Aside Allocation in outline form as directed by CMS. Outline to include medical summary, anticipated future medical requirements and prescription medication, life expectancy issues, as well as, an explanation of how set-aside allocation was determined and who will administer the set-aside trust.
The advantage of this in-house service is clear. By coordinating efforts, our attorneys can streamline the settlement process. The result is a more cost-effective and more complete defense.
For additional information on our practice, contact:
Mary E. Ingley, Esquire
mingley@mcconnaughhay.com
P.O. Drawer 229
Tallahassee, FL 32302-0229
Phone: 850.222.8121
Fax: 850.222.4359