Medicare Liens and Your Personal Injury Settlement - House Law LLC

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Medicare Liens and Your Personal Injury Settlement

What happens if Medicare pays for your medical bills resulting from a car accident, and you later receive a personal injury settlement?  Medicare has what is referred to as a “super lien” on your settlement or judgment and has the right to be reimbursed. One difficulty in handling Medicare liens is that Medicare will often claim that it is entitled to reimbursement for medical expenses that it paid that were unrelated to your settlement.  Thus, an excellent personal injury lawyer will review the Medicare claims to make sure that any treatment for which is has paid is related to your accident. 

What is a Medicare Lien? 

Medicare liens apply to treatment you receive resulting from a car accident or other injury that was another person’s fault.  And Medicare does not have to provide any notice of its lien (which is unique—in order for most liens to be valid, some form of notice must be given).  So, for example, if you are in a car accident, and Medicare pays for your resulting medical bills at the emergency room, Medicare will have a right to be reimbursed for the amount it paid for your treatment.  Federal law mandates that liability insurers must notify Medicare of any Medicare beneficiaries who receive a settlement or judgment.

Thus, when you make a claim or file suit against the at-fault driver, which results in a settlement or judgment, Medicare has a right to be reimbursed from that settlement or judgment.  If there is never a settlement or judgment, Medicare will not be reimbursed and you, as the injured party, do not then have to reimburse Medicare.

Further, while many attorneys refer to “Medicare liens,” the proper term as defined under federal law is Medicare’s “recovery claim.”

Does Medicare Have to Pay for Medical Services Resulting from an Accident? 

Sometimes, when Medicare is aware that another party may be liable for a person’s medical bills, Medicare may not pay for an injured person’s medical expenses.  However, when responsibility for the medical expenses incurred is in dispute and other insurance will not pay promptly, a medical provider may bill Medicare as the primary payer. When Medicare pays for such medical services, the payment is referred to as a “conditional payment,” meaning that such payment is subject to later recovery by Medicare.

Should Medicare Have A Right To Reimbursement

While Medicare is a government-funded program, when you have worked for years and paid into the Medicare program, you have already paid for the benefit of receiving healthcare, even when that healthcare is necessitated because you were injured by another’s person’s negligence.  Thus, arguably, Medicare is being reimbursed twice for the healthcare you are receiving—first from your years of paying into the program, and second from your settlement or judgment. This is yet another way that our federal government helps to disadvantage those who are injured.  It’s up to Congress to change this law, but unfortunately over the past several decades, both Congress and our Courts have made it more difficult for those who are injured to be made whole.


Does Medicare Provide Any Reduction for Attorney’s Fees and Expenses? 

Yes, Medicare will provide a reduction for reasonable attorney’s fees and expenses (as opposed to Self-Funded ERISA Plans,” for example).

Reducing Medicare Liens 

You must report your personal injury case to Medicare, but you may not necessarily have to pay the full lien that the COB Contractor places on your settlement. Your personal injury lawyer will ensure that any expenses Medicare is claiming are actually related to your accident and will dispute those that are not.

Medicare’s right to reimbursement is a complicated process that can take weeks or months to resolve.  Having a personal injury attorney who is experienced in handling Medicare’s right to reimbursement can ultimately result in more money in your pocket from a settlement and can ensure that Medicare does not seek reimbursement from you personally at some point in the future.

Contact A Personal Injury Lawyer 

If you have been injured in an accident and you are a Medicare beneficiary, Medicare will have an absolute legal right to be reimbursed from any settlement or judgment you receive.  Make sure you have a personal injury attorney experienced with resolving Medicare liens. If you have been involved in an accident, or if you want to talk with an attorney about making sure any liens are handled appropriately, call Aaron House today for a free consultation at 816-875-4260.

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