MSPRC Posts $300 Threshold on Liability Settlements

Medicare Set-Aside Blog on September 7, 2011 | Posted by

MS has established a $300 threshold for recovery exemption from liability settlements effective September 6, 2011. Although not the $5,000 safe harbor sought by the insurance industry in H.R. 1063, this represents some acceptance by CMS that the cost to recover in many instances is not worth the government’s efforts. The criteria established by CMS for exemption is as follows:

Beneficiary Alert: $300 Threshold on Liability Settlements

Medicare has implemented a $300 threshold for certain Liability Insurance cases. If all of Medicare’s criteria are met, the MSPRC will not recover against the beneficiary’s settlement, judgment, award or other payment.

If you’re a beneficiary, what does this mean for you?

As of September 6, 2011, if you’ve received a lump sum settlement of $300 or less, and your case meets certain conditions, Medicare will not recover from that settlement. These conditions include:

1. Your settlement is related to an alleged physical trauma-based incident, not an alleged exposure, ingestion, or implantation, and
2. You do not have any additional settlements related to the same alleged incident.


Please note that this threshold specifically excludes settlements where an insurer is paying your medicals bills directly or on an ongoing basis. This threshold also does not apply if a demand letter was already issued for your case. We have posted a more detailed explanation in the Attorney and Insurer Toolkits.


Also available at http://www.msprc.info/