Pocketing the Set-Aside?

[Sparky10]

So....what happens if you take the MSA check, cash it, and run amok; buying all the *toys* you ever wanted? Surely its been done by someone.

Is it considered Fraud? Or does it go unnoticed?

[Jo*mar]

sparky - did you ever get any PMs or answers to your question?

What is a MSA check ?- sorry i don't know what that is.

[Wink]

You need to be more detailed here. Are you talking about the "Future Medical" that is sometimes awarded in a Workers' Comp Settlement? I think if you got that part as a Lump Sum then you can do what you want with it. Afterall, it's yours.

But......if you're involved with SSDI, you don't want to Lump Sum that, as I think you'll need to use that as part of the Medicare Set-aside until it's used up for your WC injury. Then Medicare will pick up the rest.

[DiMarie]

I am not sure what medical set aside check is, how it works.
There are a few places you can check for info. One is the ssa.gov soc secuirty site, call them anonymously and ask....or if there is a legal aid in your area, ask for a consult, or ask your attorney that manages your cases.

Hope someone can find out, as I am sure this si something that happens. Especially to thoise that have had ahuge income loss, and years of battleing financial destress that to keep their home they use the set aside if it is given to them.

My impression is that medicare will not pay for the needs as you have a set aside, but if you have a secondary provider, maybe they cover needs...
I would like to find out as there is talk of settlement for a family member, and the terms used by w/c was a medical set aside....
I really would like to understand more about it before he says yes, as opposed to leaving medical open as was the case with my childs w/c settlment.

Dianne

[Sparky10]

I'm still around; thanks for noticing and trying to answer my question.
You need to be more detailed here. Are you talking about the "Future Medical" that is sometimes awarded in a Workers' Comp Settlement? I think if you got that part as a Lump Sum then you can do what you want with it. Afterall, it's yours.

But......if you're involved with SSDI, you don't want to Lump Sum that, as I think you'll need to use that as part of the Medicare Set-aside until it's used up for your WC injury. Then Medicare will pick up the rest.
Yes Wink, that is what I'm asking about..."future medicals" in a WC settlement. And yes, my BF is on SSDI+Medicare. We understand that Medicare will never pay for anything associated with his injury if he pockets the $$. With a MSA account, Medicare would pick up expenses after the $$ is exhausted.

IF he uses the $$ as it is intended, a Set-Aside account, he would be responsible for reporting every expense out of that account, and it had better be associated with his injury!

My question boils down to - HOW does he pocket the $$ and not have to account for every expense? If it goes into a savings account, and he wants to, say....pay off bills, buy a car, whatever...I just don't understand, and I don't think I'm being clear with my question. :(

Anyone understand what I'm asking? :o :confused:

[Sparky10]

Found this here: http://www.cms.hhs.gov/WorkersCompAgencyServices/08_setasiderelatedtopics.asp#TopOfPage

No Waivers of Specific Services Related to a WC Case

(Ref: 4/21/03 Memo Q18)

There is no means by which a claimant can permanently waive his or her right to certain specific services related to a WC case and, thereby, reduce the amount of a WCMSA. CMS cannot approve settlements that promise not to bill Medicare for certain services in lieu of including those services in a Medicare set-aside arrangement. This is true even if the claimant/beneficiary offers to execute an affidavit or other legal document promising that Medicare will not be billed for certain services if those services are not included in the Medicare set-aside arrangement.

What I underlined appears to be saying that CMS (Centers for Medicare/Medicaid Services) will NOT give my BF $$ if they know he plans to use it for something other than injury-related medicals.

Is that what you all read, also?

The above is an informative website...think I'll submit it
to the Useful Sites & Resources thread.

[Wink]

Sparky~
In my own WC case, the Commissioner awarded me Permanent Total Disabilty. The award includes 500 weeks x my current TTD checks and also future Medical. The IC is appealing that decision. I have faith that I will prevail.

Now...I'm still not quite sure my own undestanding is correct, but when it comes time for the actual settlement, I believe that I can Lump Sum the 500 weeks part of the settlement and pocket that (spend it any way I wish). But...with the Future Medical part of the award--I will leave that as it is (won't Lump Sum that) keep it open. THAT part will go towards the Set-Aside. See?

Is your BF's settlement going to be similar?

[Sparky10]

Good for you (financially), Wink! No, BF's idemnity (the part that is yours/his) will be less than 200 weeks. Not much $$. And the lawyer gets 1/4 of that.

Kinda wish BF had requested to keep the the medical open. He's thinking (he's got dollar signs in his eyes:rolleyes: ) he can pocket the SA lump sum and not have to account for it. He's very unhappy about the indemnity amount.

I don't know how he can do that...if its even possible.

Does anybody know? :confused:

[Wink]

Sparky~
Check over at the other board. I left you a message there, too.

[Scott1961]

into the regulations- Medicare Set Aside Trust= MSA (trust) it all depends on how the settlement is set up. the part set aside is handled by a third party insurance company and paid out in monthly instalments--you will not get your hands on it until it's time . But, if you receive a lump sum plus monthly payments (which under the new laws is mandatory if you are on SSDI or expect to be eligable for medicare within 30 mos.) what ever is left of the lump sum is yours! check it with you attorney!! But you better make sure that the settlement has been approved by/for MSA !!! or it will come back to haunt you.. if you ever file a medicare claim related to the injury , prescriptions are the big catch in the whole mess, the set aside must include projected prescription costs for life ! so that you don't spend all the money and then go to medicare in 5 or 6 years and ask them to start paying
for the prescriptions because you are disabled , not working and can't afford them. the trust is set up to send you a check each month for a specific amount of money and years ( life is best !!!) to cover your future Doctor apt. and prescriptions... make sure you look at it very carefuly befor you settle. and crunch the numbers for the past couple years and then multiply the to see what you need monthly and then to cover life expectancy # of years. I am no professional , just been going through all of this... and thought I would share >>>> hope it helps
Scott

[Sparky10]

But, if you receive a lump sum plus monthly payments (which under the new laws is mandatory if you are on SSDI or expect to be eligable for medicare within 30 mos.) what ever is left of the lump sum is yours! check it with you attorney!!
Lump sum WITH monthly payments? Never heard that mentioned. My BF is on SSDI. He already has Medicare.

Scott, is there somewhere I can go, a link, perhaps, to read about this? Or is this just what you've learned from your own experience? And what is MSA?

[CWillard]

If you do not use the Worker;s Comp MSA (Medicare) for, say, several years and you are considered stable (cured), can you then use the fund at your discretion?

[caudaequinasyndrome]

i know it can be passed down as part of your will.

[michael178]

someone ought to teach whomever wrote that sentence of the rule to write in understandable english