Yet Another Attempt to Shift CMS Costs

Wednesday, March 24, 2010 | 0

By Jon Gelman

The American Insurance Association (AIA) and collateral Industry groups have banned together in a formal attempt to avoid the Federal mandate to reimburse Medicare for conditional medical payments. This is yet a third assault on the responsibility of employers to avoid payment of medical treatment of injured workers and shift the burden upon the ailing and financially strapped Medicare. Two prior legislative attempts to modify the Medicare Secondary Payer Act (MSP) have failed.

The proposal is embraced in recently introduced HR 4796. It is an attempt to modify the Medicare Secondary Payment Act by reducing conditional payment responsibilities of Industry.

In the past, failures in the enforcement of reimbursement practices were highlighted in various investigative reports. Since the reporting of those failures, the Centers for Medicare and Medicaid Services (CMS) have enhanced its efforts to seek reimburse. The US Congress has also imposed compulsory employer/insurance carrier reporting requirements.

Recent studies presented at the National Association of Social Insurance (NASI) disclosed that the majority of conditional payment issues arise in occupational claims which traditionally are denied compensability initially by insurance carriers.

A proposal was made at the NASI meeting to provide more effective and efficient delivery of medical care to injured workers. It was suggested that medical coverage in occupational disease claims become the initial responsibility of the Medicare system who then could seek indemnification from insurance carriers and others who may be ultimately responsible. A pilot plan for this type of health care was embodied in the U.S. Senate-passed health care legislation.

Jon Gelman is a claimants' attorney based in Wayne, N.J. who has written several textbooks for practitioners in that state. This was reprinted with his permission from his blog, http://workers-compensation.blogspot.com