A look back at the document that helped shape the Medicare Set-Aside industry and a conversation with the person behind it.
No discussion of Medicare Secondary Payer (MSP) compliance or Medicare Set-Asides (MSAs) is complete without mentioning the July 23, 2001 Centers for Medicare & Medicaid Services (CMS) memorandum titled Workers' Compensation: Commutation of Future Benefits, more commonly known as the Patel Memo.
Named after Parashar B. Patel, who served as a Deputy Director at CMS at the time, the memo became one of the most influential documents in the history of workers' compensation Medicare Set-Asides.
The Patel Memo established much of the framework that shaped the MSA industry as we know it today. It introduced early voluntary review thresholds, distinguished between compromise settlements and full and final resolutuin that close future medical benefits, and outlined administrative processes for tracking MSAs and coordinating benefits after settlement. While some aspects of the memo have evolved over time, many of its core principles continue to influence MSP compliance practices today.
Over the years, the Patel Memo and the many CMS memoranda that followed were ultimately consolidated into the Workers' Compensation Medicare Set-Aside (WCMSA) Reference Guide, which now serves as CMS's primary source of MSA policy guidance. Yet the Patel Memo's influence remains undeniable. In fact, it continues to be hosted on the CMS website, making it, to this author's knowledge, the only legacy MSA memorandum that remains officially available.
What makes the Patel Memo especially significant is that it recognized and formalized practices already emerging across the workers' compensation industry in the late 1990s and early 2000s. Practitioners understood that 42 CFR 411.46 required Medicare's interests to be considered when future medical expenses were resolved through settlement. In response, parties began voluntarily setting aside funds to cover future Medicare-covered treatment. See The Use of Medicare Set-Aside Trusts in Workers’ Compensation Settlements, from the Florida Bar Journal, Vol. 74, No. 5, May 2000. In many ways, the Patel Memo was ahead of its time.
Looking back 25 years later, the memo stands as more than a historical document. It helped lay the foundation for an entire industry built around preserving the Medicare Trust Fund, protecting taxpayers, and supporting individuals after they settle their workers' compensation claims.
To mark the memo's 25th anniversary, I had the privilege of sitting down with Parashar Patel on the July 23, 2026 episode of the Ametros podcast, It's Settled.
During our conversation, we explored the regulatory and policy forces that led to the memo's creation, Mr. Patel's career at CMS, and his perspective on the memo's lasting impact. We also discussed how MSP compliance has evolved over the last quarter century and what lessons remain relevant today.
Whether you're an MSP professional, claims practitioner, attorney, or simply someone interested in the history of Medicare Set-Asides, this is a conversation you won't want to miss.
