Thoughts on Medicare Set-Aside "Experts"

A particular breed of snake-oil salesman has really gotten under my skin. They call themselves “Secondary Payer Compliance Experts.”

In a recent visit to a client in Florida, I found myself defending the New Jersey practice of having the claimant’s attorney obtain any necessary Medicare Set-Aside waivers or approvals. The best defense for this practice is that at least it is a reputable attorney doing the advocacy – with an interest in getting the lowest possible set-aside approved.

You see, I am just not convinced that these ‘compliance specialists’ are strong advocates for cramming down Medicare’s alleged interest. They may come up with the lowest possible future medical cost projections to submit to Medicare but where is the advocacy to fight to get that projection approved?

And what happens if Medicare decides later that the Set-Aside was underfunded? These snake oil salesman will be long gone, and even if they are still around, they have no duty to defend you, and no legal liability for the challenged Set-Asides.

The downside to having attorneys obtain the MSA waivers or approvals is that it is slower.

OK. That may be true, but a little delay is a tradeoff I am willing to make for accountability and advocacy.

Greg Lois is the managing partner of LOIS LLC and dedicates his practice to defending employers and carriers in New York and New Jersey workers' compensation claims. Greg is the author of a popular series of "Handbooks" on workers' compensation, and is the co-author of the 2016-2019 Lexis-Nexis New Jersey Workers' Compensation Practice Guide. Greg can be reached at 201-880-7213 or