April 18, 2019 • Compliance

Ametros in Action: Complexities in Compliance

family in park

When settling a workers’ compensation or liability case, often the injured party and their family have a lot of questions. It’s a tumultuous time already made difficult by an injury, and the complicated settlement process does not make it any easier. If the injured party is receiving a Medicare set aside (MSA), not understanding the process and what is required of them after settlement can result in the injured party not remaining compliant with the Centers for Medicare and Medicaid Services (CMS). This can potentially jeopardize their future Medicare benefits.

At Ametros, we often play the key role of helping injured parties understand and feel more comfortable with the idea of settlement, aiding them in understanding what responsibilities come with an MSA.

In the case of Thomas, his initial injury was in 1997, and included hypertension, diabetes, and several other diagnoses. Thomas and his family had been offered a settlement, and his family had many concerns.

Settlement Conference

Ametros was brought in to attend a settlement conference. After speaking with Thomas and his family, one of their main concerns was ensuring his funds would be enough for his future medical care. Our team provided a CareQuote to help show Thomas how much his medications would cost, and savings we could provide if he settled and became a member on Ametros’ platforms.

During the settlement conference, Thomas’ family explained that they wanted to use their private health insurance to pay for Thomas’ injury-related treatment. Our team helped advise that private insurance cannot be used for treatment that settlement funds should pay for. Our team also explained that if they used private insurance to pay for injury-related treatment, that would not be in compliance with CMS, and could jeopardize Thomas’ future Medicare benefits.

Future Medical Allocations

Additionally, Thomas did not understand why he was being offered two different settlement accounts. Our team helped explain that the first account was the MSA, that would need to be used on treatment that was related to the initial injury and Medicare-covered. The second was a non-Medicare account, to be used on treatments related to the injury that were not Medicare-covered such as home healthcare, home modifications, and included funds for insurance premiums for supplemental insurance.


Ultimately, Thomas and his family gained a better understanding of settlement, how settlement funds could be used, and how Ametros could help them manage the complexities of their funds. They chose to settle with professional administration for both accounts with Ametros so they would have assistance to make the most informed medical decisions possible.

Do you have questions about settlement or future medical allocations?

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