The Shift That Could Catch You Off Guard
If you’ve ever assumed Medicare compliance begins and ends with a final lien number from the Centers for Medicare & Medicaid Services (CMS), you’re not alone—but that assumption is no longer safe. CMS settlement oversight is expanding, and trial attorneys are in the spotlight.
CMS has recently signaled a much more assertive stance when it comes to how personal injury settlements are handled, particularly in relation to Medicare’s future interest.
While the specifics are still evolving, one thing is clear: settlement planning is no longer a gray area that can be glossed over. The oversight is coming, and it’s targeting precisely the kinds of cases most trial attorneys routinely handle.
What Triggered the Change?
Much of this shift stems from the increased attention CMS is paying to how Medicare’s interests are protected in settlement planning — not just lien numbers. Under the Medicare Secondary Payer (MSP) framework, Medicare may have a right to recover conditional payments when Medicare paid for medical services that should have been covered by another payer (like liability insurance) and where future medicals may still arise.
In liability settlements involving clients who are already Medicare beneficiaries — or soon will be — failing to account for Medicare’s future interest can lead to delayed benefits, denial of future coverage, or repayment demands long after the case closes.
While formal regulations around liability Medicare Set‑Asides aren’t finalized, CMS’s enforcement of MSP obligations signals that attorneys may be held accountable if a settlement fails to reasonably protect Medicare’s interests — whether through documentation, set‑aside funding, or other protective structures.
Source: CMS Medicare Secondary Payer (MSP) overview (CMS.gov) Centers for Medicare & Medicaid Services
Why This Matters for You and Your Clients
For trial attorneys, this shift presents two serious risks:
- Client Harm: An injured client who later seeks Medicare-covered care may find their benefits denied or delayed if CMS believes their settlement failed to address future medical needs.
- Professional Liability: Attorneys who structure or distribute settlement proceeds without protecting Medicare’s interests could be exposed to liability—both financial and ethical.
It’s not just a matter of regulatory compliance. It’s about making sure your client’s needs are fully addressed and your own practice is shielded from avoidable exposure.
You Don’t Need to Solve This Alone
At Architected Settlement Law Group, we’ve been watching these developments closely. We collaborate with trial attorneys nationwide to ensure that settlement plans are both CMS-compliant and client-centered.
We can help you:
- Determine whether a Medicare Set-Aside should be considered
- Coordinate with medical experts and lien resolution services
- Implement legal structures that protect your client and your practice
Avoid a Misstep That Could Cost You
The landscape is shifting, and CMS settlement oversight is no longer something you can afford to treat as optional. Even cases that seem routine—such as auto injury or premises liability settlements—may trigger scrutiny if the client has Medicare eligibility on the horizon.
Let’s talk now, before you find yourself second-guessing a distribution after the fact.
What This Means for Your Client
If your client is approaching Medicare eligibility, they may lose future benefits if the settlement plan doesn’t meet CMS expectations. That means delayed care, denied services, and unnecessary stress—all avoidable with proper planning.
What This Means for You
Failing to protect Medicare’s interests puts you at risk, too. You could face financial exposure or even ethical complaints. But with the right guidance, you can protect your clients and your reputation.
Partner with a Legal Team That Knows Settlement Planning
Schedule a Quick Call with The Architected Settlement Law Group™ today.
We’ll help you protect your clients, your practice, and your peace of mind.
