ployer, or administrator an amount for 
items and services provided to the claimant 
that is greater than the payment rate for 
such items and services established under 
the Medicare set-aside of the agreement. 
No person is liable for payment of any 
amounts billed for an item or service in 
violation of the previous sentence. If a pro-
vider willfully bills (or collects an amount) 
for such an item or service in violation of 
such sentence, the Secretary may apply 
sanctions against the provider in accord-
ance with section 1842(j)(2) in the same 
manner as such section applies with re-
spect to a physician. Paragraph (4) of sec-
tion 1842(j) shall apply under this clause 
in the same manner as such paragraph ap-
plies under such section. 
‘‘(D) AUTHORITY TO MODIFY OR TERMI-
NATE QUALIFIED MEDICARE SET-ASIDES.— 
‘‘(i) IN CASE OF DEATH OF CLAIM-
ANT.—At any time after the death of a 
workers’ compensation claimant, an indi-
vidual entitled (after such death) to dis-
bursement of the funds remaining in the 
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Medicare set-aside involved in the workers’ 
compensation claim of the claimant may 
submit to the Secretary a request to termi-
nate the Medicare set-aside upon a show-
ing of the death and payment of all claims 
that are subject to this subsection. 
‘‘(ii) IN THE CASE OF MEDICAL IM-
PROVEMENT
OR
CHANGE
OF
CIR-
CUMSTANCES.—At any time after the date 
that is five years after the date of quali-
fication of a Medicare set-aside involved, 
the workers’ compensation claimant in-
volved may submit to the Secretary a re-
quest to modify or terminate the Medicare 
set-aside upon a showing of a substantial 
medical improvement of the claimant, with 
respect to the injury or illness involved, or 
of changed circumstances of the claimant 
that justify a reduction of the funds of the 
Medicare set-aside (as in existence on the 
date of such request) by at least 25 per-
cent. 
‘‘(iii) NOTICE
REQUIRED.—The Sec-
retary may not approve a request sub-
mitted under clause (i) or (ii) to modify or 
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terminate a Medicare set-aside unless the 
workers’ compensation claimant involved or 
the individual entitled to disbursement (as 
described in clause (i)) includes with such 
request the following: 
‘‘(I) Assurances satisfactory to 
the Secretary that at the time of the 
submission of such request the claim-
ant or individual entitled to disburse-
ment sent notice of such request to 
any party that has a reversionary in-
terest to such request and that is spe-
cifically designated in the Medicare 
set-aside for receipt of such notice. 
‘‘(II) Assurances satisfactory to 
the Secretary that such notice was 
sent by certified mail to the address 
of record of such designated party. 
‘‘(III) A copy of such notice. 
‘‘(iv) PROCESS FOR APPROVAL OF AP-
PLICATIONS
TO
MODIFY
OR
TERMINATE 
QUALIFIED MEDICARE SET-ASIDES IN THE 
CASE
OF
MEDICAL
IMPROVEMENT
OR 
CHANGE
OF
CIRCUMSTANCES.—Subpara-
graphs (B) and (C) of paragraph (3) shall 
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