Question: Am I correct in my understanding that attorney fees as procurement costs are only allocable to Medicare where past medical benefits paid by Medicare are being settled or compromised along with past wage loss benefits (i.e. claim petitions)?
Pennsylvania Attorney
Answer: Correct – as we currently sit, Medicare does not allow the procurement costs of a case to be allocated to satisfaction of Medicare’s future interests (i.e. MSA evaluation and/or MSA set up). The procurement costs may only be allocated to satisfaction of Medicare’s past interests (i.e. conditional payments or CPs it may have made from date of injury to date of settlement). In the future, it may be possible to allocate procurement costs to satisfaction of Medicare’s future interests as is set forth in HR 2641, a piece of legislation sitting with the House Ways and Means Committee that purports to create safe harbors and bright line rules in the area of Workers’ Comp MSAs. Until that day (or CMS tells us otherwise), procurement costs may only be allocated to verification and resolution of the CPs paid for injury-related care from date of injury to date of settlement.
Kindest regards.
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