Medicare and PI Cases

In many of our auto accident cases and in some of our workers’ compensation cases Medicare pays a bill that is generated for medical treatment. It is usually an emergency room bill because the emergency room business office grabs the first card they can from the distressed and injured person, and many times that card is a Medicare card instead of a group insurance card or a workers’ compensation employer’s name and number. Medicare will pay the bill.

However, when the parties arrive at a point where they want to settle their claim if Medicare has paid a bill, then Medicare needs to be reimbursed. The lawyer who represents the injured person must see that reimbursement to Medicare is part of the settlement. Many of us lawyers, for years, have not taken this matter very seriously to reimburse Medicare. Now, the U.S. Department of Justice’s Attorney’s Office (in this case for the District of Maryland) issued a press release on March 8, 2019, stating that they just settled a case with a plaintiff’s law firm who had not re-paid the Medicare Conditional Payments Department as set forth in the Medicare Secondary Payer Act and related statutes, rules, and regulations.

In Philadelphia, a Personal Injury law firm settled allegations that the firm failed to reimburse the United States for payments made by Medicare to medical providers on behalf of the firm’s clients. The settlement called for repayment on the part of the law firm to the tune of $250,000.

These two enforcement actions are very clear reminders that when a party fails to reimburse Medicare, the United States CAN recover the conditional payments from attorneys or others who received settlement proceeds, specifically 42 C.F.R. Section 411.24, provides a right to recover payments from a primary plan or “any entity” including a beneficiary, provider, supplier, physician, attorney, State Agency, or private insurer that has received a primary payment.

These enforcement actions demonstrate the risks of ignoring responsibilities and failing to comply with measures under the Medicare Secondary Payer Act. It should be a simple matter to run a “conditional payment search” and to address any balances owed in advance of or as part of the settlement. Talk to your attorney and make sure this has happened because anyone can be sued for failure to repay Medicare.

–THOMAS F. BROWN, II

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