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The intent of the Medicare Secondary Payer Statute is relatively simple.
Section 1862(b)(2) of the Social Security Act (enacted in 1980) ( 42
USC 1395y(b)(2) ) provides that Medicare is not required to pay for
any item or service to the extent that payment has been made, or can
reasonably be expected to be made promptly (as determined in accordance
with regulations) under a workmen's compensation law or plan.
Most settlements of workers' compensation claims are coupled with a
waiver of claimant's rights to future medical payments from the workers'
compensation carrier. This is precisely the type of settlement that concerns
CMS because such a settlement might result in CMS paying bills that would
otherwise be the responsibility of the workers' compensation insurance
carrier.
If the settlement does not close the workers' compensation carriers'
obligation to pay for future medical bills related to the work injury,
approval of the settlement by CMS is not required. See the October
15, 2004 CMS memo, Q&A 6.
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