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Medicare lien law in personal injury claim?

Los Angeles, CA |

i have reach a fair settlement in my claim without a attorney.i want to know what is the law for medicare reimbursement. Can i pay the government direct so i can be relived from any future liability.

Attorney Answers 5


  1. Yes, you have to. Medicare is a government run plan that has a ‘super lien’ on any recovery where Medicare paid for medical services rendered. In most cases, the insurance company will not release any funds unless Medicare is added as the payee on the check.

    BEST ADVICE: First, speak with Medicare and obtain or negotiate down your bill- their claim. Make sure you obtain a written agreement of the amount arranged. Their web-site is www.cms.hhs.gov.com. Next, request the insurance carrier write two checks: (1) payable to Medicare for the $ agreed upon; and (2) the remaining balance payable to yourself.

    You can always consult with a local attorney regarding your rights- most offer free consultations. Good luck.

    Richard A. Cruz, Esq.
    www.cruzinjurylaw.com


  2. First, congratulations on settling your claim without an attorney. I don't know any details about your claim, but I hope you did negotiate a fair settlement, and that you can resolve the Medicare lien issue on your own. Unfortunately, because of the huge volume of reimbursement claims by Medicare, it often takes a long time just to find out what amount Medicare claims you owe as reimbursement out of the proceeds of your settlement of the third party claim. You can and will, indeed, pay the Federal government directly to reimburse CMS for its expenditures on your behalf. In fact, for its own protection, the liability insurer will insist that CMS is taken care of in order to avoid personal liability for the Medicare claim. The process can get complicated, but hopefully you can work your way through it with help and information from CMS and perhaps others. Good luck.


  3. The process of resolving the lien, is likely to be quite long. Don't expect to get any significant information over the telephone, and don't expect them to be directly responsive to your letters; but you should deal with them in writing. If you will call or e-mail my office, I will forward an 800 telephone number to use to get the process started. Don't ignore the situation either; if you are caught later on, you may find that you will lose some future medicare benefits. I have forgotten for sure, but I believe they also have the right to assess some penalty(ies) as well.

    Ideally, you should have known the amount of your lien BEFORE you settled your case. Having settled the case, and still having to determine and resolve the lien, it remains to be seen just how "fair" your settlement was.

    You can take action now to determine roughly how much the lien is. First, make a list of the providers who treated you for your injury. Second, contact the providers (or look at their bills) to see how much Medicare paid. Once you have identified all the providers, and the amounts of all the payments you will know the amount of their claim. The good news is, they typically pay only tiny fractions of the totals bills.

    Once you have an address to deal with Medicare, you want to request that they provide you with an itemization for what they have paid. When you receive that itemization, you want to review it line by line. Frequently they will include charges that have nothing to do with your case, and they will remove them once you astisfy them that they are unrelated.

    As for future medical expense, perhaps your doctor will support you that there is no reasonable expectation of the same; then there will be no basis for claiming a holdback. You may have to retain counsel yet. Good luck.

    The author of this post is licensed to practice law in the District of Columbia, Maryland, and Virginia. This post is intended as general information only, and is not provided as legal advice in connection with any specific case, and does not create an attorney-client relationship.


  4. You are obligated to pay off Medicare, and it is possible that the insurer will not issue a check without Medicare listed as a payee. Getting the total lien amount claimed by Medicare is a slow process and I typically start that inquiry on the day I am retained. So as others have pointed out to you, it is a slow process and you should not expect anything to happen right away. And congratulations, too.


  5. Yes, if Medi-Care has a lien, you are required to reimburse it out of the settlement. You may be able to negotiate a reduction of the lien, so try that with them first.

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