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iMSAs: A Dangerous Deal, What You Need to Know Before you 'Buy" in

The market for guaranteed Medicare Set-Aside arrangements in workers' compensation cases remains complex and often opaque. This complexity has unfortunately created opportunities for products promising simplicity and cost savings, but which may carry substantial risks. One such product is the Indemnified Medicare Set-Aside (iMSA). While the concept of an iMSA—an evidence-based estimate of future Medicare-covered medical expenses designed for the purpose of sidestepping CMS review—is appealing, potential downsides require careful consideration. Particularly in a new era of heightened compliance scrutiny in which Medicare will be notified as of April 4, 2025, of not only those iMSA values, but also that the parties chose not to submit them for Medicare’s approval.
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Impact of Section 111 Reporting on Conditional Payment Resolution

With all of the recent changes, updates, and alerts coming from CMS, it is important to remember that various aspects of MSP compliance directly impact one another. Namely, Section 111 reporting and conditional payment appeals. This past week, AKCS was tasked with resolving a lien in excess of $350,000 and a detailed analysis of the Section 111 reporting proved to be key in reducing this amount to $0.
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WCMSA 4.2 Update

The Centers for Medicare & Medicaid Services (CMS) has released the latest version of the WCMSA Reference Guide. Effective July 17, 2025, CMS will no longer accept or review WCMSA proposals with a zero-dollar ($0) allocation. Entities must now consider specific parameters to determine if a $0 WCMSA allocation is appropriate and maintain documentation to support that allocation.
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