When a person suffers a personal injury, such as a car accident, that was caused by the negligence of someone else, the injured person may be entitled to collect monetary compensation for medical bills, lost wages, pain and suffering, or other losses. Settling an injury claim has never been more difficult. Over the past several years, various entities have begun claiming liens or rights of reimbursement on injury settlements or recoveries. These entities will not do anything to assist in the recovery of the funds. Instead, they want the injured person or his/her attorney to do all the work and then pay them back in the end. These various entities can include Medicare, Medicaid, or even the person’s health insurance company. Over the next few weeks, we will look at these different entities and why it is important to be aware of them when settling or receiving compensation for a personal injury claim.
This week: Medicare.
Medicare is United States government-run health insurance plan which provides health insurance to people who are 65 years old or older, or who meet other special criteria. When a Medicare recipient suffers a personal injury and Medicare makes payment to a medical provider on behalf of the Medicare recipient, Medicare has a lien on any proceeds that the injured person receives to the extent of Medicare’s payments. This means that Medicare must be paid back for any payments Medicare has made. If Medicare is not paid back, Medicare can pursue the Medicare recipient or the attorney, if an attorney was representing the Medicare recipient, for the money.
Dealing with Medicare is not an easy task. Medicare is under-funded and the employees are over-worked. Getting information from Medicare takes time and patience. It requires notifying Medicare early with the correct information, reviewing the payments that Medicare claims are related to the injuries sustained in the injury, and then obtaining the correct final information. When Medicare makes a claim for reimbursement, it may include charges for totally unrelated medical treatment. It is very important to make sure that only charges related to the injuries for which the person is making the recovery. The final step is to make sure that Medicare is paid within 60 days of the injured person or attorney receiving compensation.
Beginning in 2009, Congress enacted new legislation which changed some of the reporting requirements for Medicare. These new laws are being phased in over time. The changes require insurance companies to notify Medicare when they settle a claim involving a Medicare recipient. The laws impose severe penalties on insurance companies who fail to make the reports. As a result, the insurance companies are going overboard and reporting every settlement to Medicare. This is overkill and is not required by Federal law. When dealing with Medicare, it is important to know the law and procedures that are applicable.