Medicare pays doctor’s bills, hospital bills and nursing home care. If the Medicare patient needs these types of medical care because of an accident, Medicare pays on the expectation that at the end of the case, Medicare will be reimbursed out of the settlement.
One of my clients is a Medicare recipient. He was injured about 18 months ago and all of his medical bills, including his hospital, emergency room, nursing home charges and doctors bills were submitted to Medicare. They totaled over $250,000. Medicare paid them at a reduced rate, and has a lien on the settlement for close to $100,000.
So how does medicare’s lien get paid off?
Medicare has contracted with MSRPC to handle its worker’s compensation liens, and third party liability cases. When the case settles, MSRPC reviews the final settlement paperwork, and then reduces its lien pro-rata for the costs of collection paid by the Medicare recipient. In other words, if the Medicare patient paid 33 1/3% to his attorneys, then medicare will reduce its lien by 1/3rd. MSRPC will send a letter within 65 days after the case settles to advise what the exact lien amount is, and that amount must be paid within 60 days.
There is no federal statute requiring that Medicare’s name be included on the check. Medicare law requires the insurance company to notify medicare (MSRPC) of the claim, and if it does so, the insurance company has satisfied its obligations. The patient’s obligation is to pay the lien. If the patient does not do so, Medicare can deduct the cost of the lien from his future Social Security checks or deny future medicare benefits.
Right now only Worker’s Compensation benefits are included in the statute. But, attorneys handling liability claims in general are following the same settlement procedure model that is required in all worker’s comp cases. Also, MSRPC wants people who are almost 65 to advise Medicare of a liability claim so that Medicare can be aware of it.