Medicare Secondary Payer Rule (MSP)

Medicare will not pay for an item of service to the extent that payment has been made or can reasonably be expected to be made by other health insurance. The Centers for Medicare & Medicaid Services (CMS) has taken the position that a clinical trial sponsor’s agreement to pay for services related to research-related injuries makes the sponsor the primary payer for such costs under this rule because the promise to pay constitutes a plan or policy of insurance under which payment can reasonably be expected. Submitting a claim to Medicare when other health insurance has not first been billed could be considered a “false claim”, with potentially significant penalties.