In 1980, Congress enacted the first of a series of provisions that made Medicare the secondary payer to certain additional primary plans. These provisions are known as the Medicare Secondary Payer (MSP) provisions and are found at section 1862(b) of the Social Security Act (the Act).
Fidelity Fiduciary Company, LLC (FFC) was founded in 2001 when leading workers’ compensation experts recognized an industry-wide need to provide a resource of competent and compassionate payers to guide and assist the more complex injured workers’ financial needs. FFC, a forerunner of its kind, was founded two years before the Medicare Modernization Act (MMA) was enacted in 2003, which produced the largest overhaul of Medicare in the public health program's 38-year history, including “Medicare Set-Aside” (MSA) funds.
Once a Workers’ Compensation (WC) or Liability (L) claim settles in partnership with Medicare, they become WCMSA or LMSA’s with settlement funds “set aside” for future medical/Rx payments. A decision will be made whether the funds will be professionally administered or self-administered. As a truly Professional Administrator, FFC has contractual duties for Medicare compliance, including:
- Pay medical and pharmacy charges until the fund is temporarily or permanently exhausted.
- Adjusting medical bills to the appropriate reimbursement rate such as Workers’ Comp fee schedules or Usual and Customary.
- Place the funds in an interest-bearing bank account.
- Distribute funds from the account solely for expenses related to medically necessary services or supplies or prescription drug expenses, which are injury-related and would otherwise be reimbursable by Medicare.
- Reimburse Medicare if they have erroneously paid benefits while the funds were under professional administration.
- Maintain accurate accounting records, notifying Medicare annually and anytime funds exhaust.
Additionally, FFC is the ONLY custodial company that guarantees the MSA funds will not be subject to seizure or garnishment by creditors. FFC will allow the settling parties to avoid concern that the medical funds could be attacked by creditors. After successfully handling MSA accounts for almost two decades, FFC stands ready to comply with all applicable Medicare regulations while providing compassionate service.