Congressman Pete Stark Requests GAO Study into Medicare Secondary Payer Procedures

Last month, Congressman Pete Stark, Chairman of the Subcommittee on Health, Ways and Means Committee, sent a letter to the Government Accountability Office (GAO) formally requesting that the GAO conduct a study into the issues surrounding Medicare Secondary Payer rules as they pertain to non-group health plans.

In this letter Congressman Stark reaffirms Medicare’s role as a secondary payer when Medicare beneficiaries have received payment for medical care following a liability, no-fault, or workers’ compensation settlement.  This letter also brings attention to the difficulties the settling parties are encountering when trying to obtain information from the Centers for Medicare and Medicaid Services (CMS) such as conditional payments and approval of a proposed Medicare Set Aside Arrangement.

This letter references two pieces of legislation as the catalyst for this study and specifically asks the GAO to address these questions:

1.   What aspects of CMS’s reporting and settlement procedures create challenges for  non-group health plans and what options could help address them?

2.   What are the current MSP workload, costs, and the amount of collections from the non-group health plans and how is that anticipated to change under mandatory reporting?

3.   What process does CMS use to track spending on beneficiaries who have received MSAs in workers compensation settlements and how much of the MSA money has been used to pay for Medicare covered services?

4.   What have been CMS’s timeframes for responding to requests from settling parties for information on Medicare’s interest in settlements?

An important thing to remember throughout all of this is that GAO studies have historically led to remarkable changes in the Medicare Set Aside (MSA) industry.  It is widely known that the last study the GAO conducted in the MSA arena led to the release of the “Patel Memo”, which announced that MSAs were now CMS’ preferred method of protecting Medicare’s interest in workers’ compensation cases.  While it may be presumptuous to assume another blockbuster change is on the horizon, Congressman Stark’s letter does give an indication that changes are being considered.

To view Congressman Stark’s letter, please click here.


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