What to do when you represent a Medicare beneficiary in a lawsuit

Posted on: May 19th, 2016 by Mark R. Friedman

If you are a Medicare beneficiary filing a lawsuit, or an attorney representing a Medicare beneficiary in a lawsuit, you should be aware of your obligations to Medicare.

By law Medicare is a secondary payer, meaning that if Medicare makes payments for which someone else is ultimately responsible (such as a tortfeasor, liability insurer or worker’s compensation insurer), Medicare will demand reimbursement.

In other words, if you suffer an injury and need care, Medicare may make payments for your care.  But if you later recover on that injury, whether it’s in a lawsuit settlement, judgment, or worker’s compensation award, Medicare may demand repayment of those conditional payments (so called because Medicare’s payments are conditioned on being repaid if someone else is ultimately responsible to pay for care).

If you don’t comply with legal requirements to repay Medicare, you may be charged interest, or sued by the government, or Medicare may refuse to pay for further care for you.  The penalties are stiff, so it’s important to comply.

When the lawsuit is first filed, you should inform Medicare’s Benefits Coordination and Recovery Center (BCRC).  You can do so by mail or fax, but the quickest way is by phone at 855-798-2627.  BCRC’s contact info is listed online.

Once BCRC initially processes your case, they will send you a Rights and Responsibilities letter.  At that point (or about three days after notifying BCRC by phone) you can call BCRC and request a Case ID Number.  With the Case ID Number in hand, you can log on to the Center for Medicare and Medicaid Services’ (CMS) online recovery portal, the Medicare Secondary Payer Recovery Portal (MSPRP), to manage the case going forward.

While the case is ongoing, you can use the MSPRP to request an interim Conditional Payment letter, which shows the current amount for which Medicare will demand repayment.  The amount in the interim letter may not be final, as Medicare may make more conditional payments while the case is ongoing.  Once the case settles (or a judgment is issued or worker’s compensation award made, or other resolution), you should notify Medicare via the MSPRP and request a final Conditional Payment letter showing the final payoff amount.  You should review the final Conditional Payment letter to make sure all of the payments are for care related to the injury on which the lawsuit was based.  The letter should contain instructions on appealing if you want to challenge the payoff amount, e.g., if not all the payments were for care related to the injury.

Beneficiaries of Medicare, Medicaid and other government benefits programs may have strict obligations when pursuing a legal claim.  At FriedmanLaw we advise beneficiaries of public assistance and their attorneys on how to comply with program requirements and maximize benefits.  For advice on your situation, call or email us today.

As this website provides general information and isn’t tailored to your particular situation, it doesn’t constitute legal advice and may not take into account rules and exceptions that affect you. Although updated from time to time, this website may not take account of recent legal developments or differences in laws from state to state. For safety sake, obtain individual legal advice before you act! You assume all risk of acting on information contained in this website. This website doesn’t constitute legal advice, and no attorney-client relationship exists unless FriedmanLaw and you execute a written engagement agreement. Please contact us at 908-704-1900 to discuss engaging FriedmanLaw to help resolve your legal concerns.
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