What is the medicare lien law in a personal injury case?

Asked over 4 years ago - San Jose, CA

I have reach a fair settlement with out a attorney in my personal injury case. I want to know what is the federal law? can i pay medicare directly because i don't want to be liable.

Attorney answers (6)

  1. Steven Ronald Kuhn

    Contributor Level 15

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    Lawyer agrees

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    Answered . Under Federal law Medicare has a right to recover for medical bills they have paid. It takes them a long time to respond to inquiries. There is a formula they use to determine the amount of reimbursement. Contact them to find out the amount.

  2. Adam David Sorrells

    Contributor Level 13

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    Lawyer agrees

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    Answered . The other providers have done an excellent job answering this question, and I will not duplicate their efforts. However, I will provide the address to send your inquiry to.

    Medicare Coordination of Benefits
    Claims Investigation Unit
    P.O. Box 33847
    Detroit, MI 48232

    You will need your social securuty number on the letter, and some other basic information. You can also call them to report the claim. You can find the number through a Google search.

    Adam Sorrells
    Chico Injury Lawyer

    Disclaimer: The following was not legal advice, and cannot be relied on. For informational purposes only. Time is of the essence.

  3. Noelle Marie Natoli

    Contributor Level 9

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    Lawyer agrees

    Answered . The law on medicare liens is actually quite complex. The short answer is, if Medicare has paid any portion of your medical bills, they are entitled and probably will seek reimbursement of those funds. You should contact them directly, advise them of your situation, and ask them if they are asserting a lien, or seeking recovery. They will let you know an exact amount if they want to be reimbursed. Unfortunately, this process can take months, so you should set aside some, if not all, of the settlement funds to negotiate this payment. Be advised that Medicare will likely want to be paid for both your past medical expenses, and will want you to set aside some funds for possible future medical expenses related to your injury. You may want to speak to your physician to find out if he can give you an estimate for any future medical expenses you might need. Good luck!

  4. Steven Ronald Kuhn

    Contributor Level 15

    1

    Lawyer agrees

    Answered . Under Federal law Medicare has a right to recover for medical bills they have paid. It takes them a long time to respond to inquiries. There is a formula they use to determine the amount of reimbursement. Contact them to find out the amount.

  5. Joseph A Blaszkow

    Contributor Level 15

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    Lawyer agrees

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    Answered . Ms. Natoli is correct that 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.

  6. Lars A. Lundeen

    Pro

    Contributor Level 20

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    Lawyer agrees

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    Answered . Medicare has a federal statutory lien which needs to be paid at the end of your case, when you recover money. You will be able to offset a proportional share of the costs you incurred in obtaining the settlement monies.

    Medicare lien reimbursement rules are currently in flux. You may be required to establish a Medicare set aside trust in order to be sure that future related medical bills are paid from your recovery and not thrown back onto Medicare once again. You are entitled to receive in your settlement the full reasonable value of your medical bills, not just the amounts that have been paid by Medicare. Knowing that, do you still believe you are receiving full and fair value for your claim? Often the insurance carrier will attempt to classify the bills at Medicare rates, which is not correct.

    In order to adequately protect yourself, I suggest that you contact a knowledgeable personal injury attorney in your area to see whether or not you are being offered fair value for your claim. Most personal injury attorneys will provide you with a free initial consultation, so I suggest you take advantage of this service before making any final decision on settlement.

    Legal Disclaimer:

    Mr. Lundeen is licensed to practice law in Florida and Vermont. The response herein is not legal advice and does not create an attorney/client relationship. The response is in the form of legal education and is intended to provide general information about the matter within the question. Oftentimes the question does not include significant and important facts and timelines that, if known, could significantly change the reply and make it unsuitable. Mr. Lundeen strongly advises the questioner to confer with an attorney in your state in order to insure proper advice is received.
    Legal Disclaimer:

    Mr. Lundeen is licensed to practice law in Florida and Vermont. The response herein is not legal advice and does not create an attorney/client relationship. The response is in the form of legal education and is intended to provide general information about the matter within the question. Oftentimes the question does not include significant and important facts and timelines that, if known, could significantly change the reply and make it unsuitable. Mr. Lundeen strongly advises the questioner to confer with an attorney in your state in order to insure proper advice is received.

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