A Medicare Set-Aside (MSA) is a settlement tool used by parties to prevent a cost shift of future injury-related Medicare covered expenses to Medicare when the settlement terms close out liability for future medical.

Section 25.5 of the Illinois Workers’ Compensation Act (820 ILCS 305/25.5) governs workers’ compensation fraud in Illinois. 

It is well recognized in the disability and healthcare literature that the longer amount of time an injured employee stays off work, the lower the chances are for a successful recovery and return to work.

On December 7, 2018, the Appellate Court of Illinois issued a Decision in William Pisano v. The Illinois Workers’ Compensation Commission (City of Chicago), 2018 IL App (1st) 172712WC, which sheds further light on awards for permanent partial disability in cases where multiple accidents and injuries are at issue, and a wage loss results as one of the cases.

On May 20, 2019, the Illinois Workers’ Compensation Medical Fee Advisory Board announced a Proposed Amendment to the Workers’ Compensation Commission’s Administrative Rules.

On May 17, 2019, Illinois Governor Pritzker signed SB 1596 into law as Public Act 101-6. The law amends the Illinois Workers’ Compensation Act (“WC Act”) and Occupational Diseases Act (“OD Act”). 

Prescriptions for compounded medications should be red-flagged and quickly assessed for more appropriate and cost-effective alternatives. Don’t wait until trial or settlement to address unnecessary use of these medications.

A few months ago, we submitted an MSA in a case where Lyrica was being prescribed “off-label” for a diagnosis of lumbar radiculopathy.  CMS included it in the MSA.  The inclusion of Lyrica inflated the MSA astronomically, and nearly prevented the case from settling.  I received this question:  “How can the rules just change like this?  Isn’t there some sort of advance notice required for changes like this?  This just isn’t right!”

On April 1, 2019, the Medicare Secondary Payer Recovery Portal (MSPRP) was updated with a new feature, offering primary payers to also pay conditional payment debts electronically.

Projecting for Workers’ Compensation Medicare Set‐Asides (MSA) in order to prevent a cost shift burden to Medicare has been an evolutionary process since it began.