Health Advocates Inc. has filed suit against the Social Security Administration over procedural changes the company contends hinder its work to ensure that workers' compensation settlements are in line with Medicare requirements.
The Tampa, Fla.-based company helps workers' comp insurers establish trusts for settlements. The company says under the changes it would no longer be able to process documents from a central location and would have to pay a fee for information.
Under guidance from the Centers for Medicare and Medicaid Services, all workers' comp settlements totaling more than $250,000 involving workers who could become Medicare eligible within 30 months should be reviewed to ensure that Medicare does not begin to pay for care until the settlement runs out, which is done through a set-aside trust.
According to the suit, Health Advocates performs the checks through a Tampa branch office of the Social Security Administration (SSA). A database is maintained by the SSA containing information about Social Security beneficiaries, including the dates when individuals became or will become entitled to receive benefits.
"The process worked simply," the company said in its complaint, which was filed in a Florida federal district court.
SSA officials received a signed consent form. They would check through the nationwide database to see if the individuals were eligible, or could reasonably be expected to become eligible within the next 30 months.
The company said it submits roughly 500 such requests each month and the requests were filled without charge.
Earlier this year, the SSA made procedural changes reducing the ability of companies such as Health Advocates to obtain that information.
Under the new rules, requests for eligibility information are required to be made at the SSA branch office nearest the individual's home, and there is a $49 fee to fill each request.
Despite the existence of a Medicare set-aside industry since 2001, and the potential cost to Medicare if the secondary payer status is not protected through the arrangements, the SSA lacks any policy or centralized response to handling information requests, Health Advocates charges. It said offices lack standards under the plan and requests are repeatedly turned down despite proper forms.
June Simpson, president of Health Advocates Inc., said it is "unfortunate" that the company "has been forced to file a lawsuit against the Social Security Administration to compel them to provide the information needed to reimburse Medicare for expenses that were not their responsibility, and more important, to avoid payment of future medical expenses that are not Medicare's responsibility."
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.