Medicare Reimbursement Claims

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (Public Law 108-173) was enacted in December 2003, giving the government the right of reimbursement it sought in Thompson v. Goetzmann, 315 F.3d 457 (5th Cir. 2002); Brown v. Thompson, 4th Circ (3/20/03); and U.S. v. Baxter, 11th (9/15/03).

Four years later the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) added more penalties for non-compliance to the Medicare Secondary Payer (MSP) Statute.  Section 111 of the MMSEA requires the providers of liability insurance (including self-insurance), no fault insurance and workers’ compensation insurance (hereinafter “insurers”) to determine the Medicare-entitlement of all claimants and report certain information about those claims to the Secretary of Health and Human Services.  The penalty for non-compliance with Medicare reporting standards is strict: $1,000 per day for each day the insurer is out of compliance.

The MMSEA significantly changed the way in which attorneys handle cases. No longer is it acceptable for settling parties to react only after receiving notice of a potential claim from the Centers for Medicare & Medicaid Services (CMS). Medicare is not required to send notice – the obligation lies with the claimants and their attorneys. Regulations mandate that Medicare’s interests must be satisfied prior to the distribution of settlement proceeds. 

When it comes to lien resolution - Medicare lien resolution - in particular, attorneys across the country turn to GRG to ensure absolute Medicare compliance. Failing to address Medicare reporting obligations can lead to serious issues with claimants' government assistance and/or healthcare coverage.  

How does GRG help?

Full Resolution Process: Medicare Reimbursement Claims

  • Evaluate case and establish dialogue with the respective tort recovery department and submit formal lien inquiry
  • Audit and analyze all reimbursement claims to determine accuracy and “carve out” items unrelated to injury/settlement
  • Review and settle all relevant claims to minimize the lien obligation (date of injury - date of settlement)
  • Secure final payment demand from Medicare and provide reimbursement instructions to your firm
  • Provide regular status updates on your case
  • Includes all waivers and compromises (if applicable) to ensure appropriate recovery for the claimant 

How is GRG uniquely qualified to handle Medicare liens? 
In working with numerous mass tort and personal injury firms that in aggregate provide a consistent pipeline of cases, GRG is able to navigate the MSP system and leverage significant efficiencies. Firms that engage GRG’s vast resources:

  • Expedite the process
  • Achieve more favorable results
  • Significantly lower internal costs, lost opportunities, and financial risks associated with complex obligations
  • Eliminate post-settlement liability related to Medicare
  • Protect claimants’ Medicare cards

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