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CMS Medicare Set-aside Arrangements No Statute of Limitations


CMS Medicare Set-aside Arrangements No Statute of Limitation

A CMS Medicare Set-aside Arrangements announcement was published today.  The CMS announced a very serious revelation on their authority.   CMS is an acronym for the Center for Medicaid/Medicare Services.

Banner Of 50 Anniversary CMS Medicare Set-aside arrangements 1965
(c) cms.gov

Recently, I had posted a few times on the Centers for Medicare/Medicaid Services (CMS). One question that remained in my mind was how many look-back years  the agency would be allowed for their enforcement of MSA’s. I was under the impression the statute of limitations was six years from the original claim date. A recent town hall teleconference by CMS may have changed my conclusion.

One of the their representatives indicated the six year statute actually runs from the date of settlement. When questioned further, they said that there were other actions that they could take even if the six year statute had expired. The six year statute of limitations only applies to court actions. I paraphrased the exact quote somewhat.

One has to wonder what this actually meant. With a Federal Government that is sorely short on funds, would pursuing all files for all years where CMS’s interests were not protected end up as a cash cow? I definitely think so.

This situation will develop over time.  In a few years, we will be able to more easily comment on the MSA rules.

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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