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Medicare Set asides – Federalization of Workers Compensation


The Federalization of Workers Compensation – Medicare Set-asides

The medicare set-asides rules have been law for quite a few years.   I have posted often on this subject lately as I think we are seeing the trees in the forest. I want to try to examine the forest in the Workers Compensation environment on this subject.

Graphic Of Heart Beat Medicare Set-asides On Cross

The Center for Medicare/Medicaid Services (CMS) and Medicare Set-asides (MSA) are beginning to reach a fever pitch judging from some of the blogs and newsletters that I subscribe to for daily Workers Comp information and news.

The State of Maryland has now made MSA’s mandatory for all Workers Comp claims. I think we will see more of this type of state legislation which is really federal legislation enacted by the states.

Congress is now debating a bill that would remove antitrust status for ALL health insurance carriers. Workers Comp cannot be that far behind. In my opinion, this is a disastrous move that will be borne by taxpayers and premium payers.

Some carriers and TPA’s have already been contacted by CMS contractors (shudder) to make sure their lien is protected. This is very early in the process for contractors to already begin contacting carriers and TPA’s.

We now have many trees in which to make a forest – The Complete Federalization of Workers Compensation. When I advise employers, investment companies, investment advisors, and other firms on Workers Compensation I have always input into the conversation the fact that Workers Compensation is going to be eventually federalized.

Picture Female Doctor and Nurse Medicare Set-asides Portrait

Oh, and I almost forgot. The recent financial package passed by Congress ENACTED A FEDERAL INSURANCE OFFICE (FIO). I will post on that soon. We now have two federal bureaus, the CMS and the FIO that have been collecting data from Workers Comp insurance companies payments made on Workers Comp claims. Are you now seeing the forest?

I could take that data and analyze it in so many ways that it would make it much easier to see patterns in the data to possibly make more rules and legislation. Could a federal agency use the data they are collecting for other means? I will leave that one to you and the trees and the forest to answer.

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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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