Workers' Compensation: DOGE and Medicare Set Aside Agreements

This is the first in a series of posts concerning the potential impact of the US Department of Government Efficiency (DOGE) on the nation's patchwork of workers' compensation systems.

The "DOGE" initiative focuses on efficiency and fraud within the Centers for Medicare & Medicaid Services (CMS). It may cause serious repercussions in the workers' compensation system, particularly concerning Medicare Set-Aside Arrangements (MSAs). Significant workforce reductions within the Department of Health and Human Services (HHS) are ongoing, and the termination of contractual services has already been attributed to DOGE as it downsizes the government. DOGE has already initiated actions. Here's how:

www.doge.gov

Potential Impacts:

Increased Scrutiny of MSAs:

If "DOGE" intensifies efforts to identify and eliminate wasteful spending, it's plausible that MSAs will face heightened scrutiny. This could lead to stricter reviews of MSA proposals, focusing on ensuring that allocated funds are vital and accurately calculated.
The goal would be to prevent over-allocation of funds, which could potentially drain Medicare resources.

Changes in MSA Policies and Procedures:

"DOGE's" focus on efficiency could result in changes to the policies and procedures governing MSAs. This might include:

Streamlining the MSA review process.
Implementing new guidelines for calculating MSA amounts.
Increasing the use of technology to monitor MSA spending.

Impact on MSA Calculations:

If "DOGE" were to enforce stricter rules regarding what medical expenses are deemed "reasonably certain" to be needed in the future, it could lead to changes in how MSA amounts are calculated. This could result in lower MSA allocations in some cases.

Fraud Detection:

One of DOGE's main areas of focus is fraud detection. Therefore, any fraudulent activity related to MSAs will be under more scrutiny, which could decrease the number of fraudulent MSAs.

Potential for Delays:

With increased scrutiny, there is also the potential for delays in the MSA approval process. This could create challenges for injured workers and insurers seeking to settle workers' compensation claims.

Key Considerations:

The extent of "DOGE's" impact on MSAs will depend on the specific actions taken by the initiative and CMS.
Any changes to MSA policies and procedures must comply with existing federal laws and regulations.
It's important to monitor developments related to "DOGE" and CMS to understand the potential implications for the workers' compensation system.

In essence, "DOGE's" drive for efficiency and fraud prevention within CMS could significantly change how MSAs are handled, focusing on ensuring responsible stewardship of Medicare funds. DOGE's actions impacting CMS reductions in workforce, financial contract cancellations (impoundment of funds), and fraud audits may substantially affect the nation's workers' compensation programs.

Related Resources:

DOGE and "Waste, Fraud, and Abuse" CATO Institute 02/20/25

DOGE shared its receipts -- and some of them don't match Politico 02/22/25

Recommended Citation: Gelman, Jon., DOGE and Medicare Set Aside Agreements, www.gelmans.com (02/23/2025) https://workers-compensation.blogspot.com/2025/02/doge-and-medicare-set-aside-agreements.html

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*Jon L. Gelman of Wayne, NJ, is the author of NJ Workers' Compensation Law (West-Thomson-Reuters) and co-author of the national treatise Modern Workers' Compensation Law (West-Thomson-Reuters). For over five decades, the Law Offices of Jon Gelman 1.973.696.7900
jon@gelmans.com has represented injured workers and their families who have suffered occupational illnesses and diseases.

Blog: Workers' Compensation

LinkedIn: JonGelman

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Author: "Workers' Compensation Law" West-Thomson-Reuters

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