Health Advocates Inc. has filed suit against the Social SecurityAdministration over procedural changes the company contends hinderits work to ensure that workers' compensation settlements are inline with Medicare requirements.

Health Advocates, based in Tampa, Fla., is a company that helpsworkers' comp insurers establish trusts for settlements. Underguidance from the Centers for Medicare and Medicaid Services, allworkers' comp settlements totaling more than $250,000 involvingworkers who can be expected to become Medicare eligible within 30months should be reviewed to ensure that Medicare does not beginpaying for care until the settlement runs out, which is donethrough a set-aside trust.

Health Advocates performed the checks through the Tampa branchoffice of the Social Security Administration. The Administrationmaintains a database that contains, according to the suit,information about beneficiaries of Social Security programs,including the dates upon which those individual beneficiariesbecame or will become entitled to receive benefits under suchprograms.

"The process worked simply," the company said in its complaint,which was filed in a Florida federal district court. "HealthAdvocates would present a signed consent form from the individualbeneficiary, and SSA (Social Security Administration) personnelwould check the nationwide database to confirm whether theindividual was presently eligible for Medicare, or could reasonablybe expected to become eligible within the next 30 months."

In its complaint, the company said that it submitted roughly 500such requests each month during the past several years, and thatthese requests were filled without charge.

Earlier this year, however, the SSA made procedural changes thateffectively reduced the ability of companies such as HealthAdvocates to obtain that information. Under the new rules, therequest for eligibility information is required to be made at theSSA branch office nearest the individual's home, and theAdministration has also begun charging a $49 fee to fill eachrequest.

"Despite the existence of a Medicare set-aside industry since2001, and despite the enormous cost to the federal government offailure to protect Medicare's secondary payer status throughadequate set-aside arrangements, SSA does not have a centralized orregional system for handling information requests related toMedicare set-asides and has no coherent national policy on thesubject," the company said in its complaint. "Instead, each SSAfield office exercises standardless discretion to honor or refuseinformation requests. Health Advocates' information requests havebeen denied repeatedly by various field offices, despite HealthAdvocates' submission of an official SSA request form signed by thebeneficiary, and even when the requests relate solely tobeneficiaries who reside in the geographic area of the relevantfield office."

June Simpson, president of Health Advocates Inc., said it is"unfortunate" that the company "has been forced to file a lawsuitagainst the Social Security Administration to compel them toprovide the information needed to reimburse Medicare for expensesthat were not their responsibility, and more important, to avoidpayment of future medical expenses that are not Medicare'sresponsibility."