CMS/SSA Form SSA-632-BK for client waiver

Question: I am a plaintiff's attorney in Orange County, California. Thank you for e-mailing me a copy of your recent FAQ's, “For Dealing With Medicare Reimbursement.” I particularly appreciated your FAQ # 17 entitled "Can the Medicare recovery amount be waived in favor of the beneficiary?"

I would appreciate your assistance in how to obtain a copy of the CMS/SSA Form SSA-632-BK in regard to my client's case. I need to submit it to the Medicare Reimbursement contractor as soon as possible.

I have settled my client's case for $60,000, which is the best I could do under the facts of the case. The CMS Payment Summary indicates total charges of $101,456.64 with conditional payments of $30,385.40. My client is in very bad financial shape and about to lose her home to foreclosure. If Medicare would waive their lien it would mean a lot to her.

Thank you for your time in this matter. I would appreciate your earliest response as my client is in severe financial distress.

California Attorney

Answer: Your client’s situation meets the criteria for a waiver based on good equity and financial hardship. I will email you the waiver form that must be completed and submitted to Medicare AFTER you have requested the final demand from Medicare, waivers cannot be reviewed until the final demand is issued. Also, when submitting the completed form you should also include a compelling story which defines the facts of the case, your client’s current situation and how the funds will be used by the client should a waiver be granted. If you need assistance please do not hesitate to contact me.