Post-settlement Payment to Medicare

Question: Over three years ago we settled a Fen Phen claim for a client that was not eligible for Medicare yet. Even though they were not eligible, out of caution we submitted to CMS/Medicare a listing of all of our Fen Phen clients (including this client) to confirm that liens did not exist. Medicare did not respond in regard to this client's status.

CMS states, "Also, any previously settled portion of the workers compensation claim must be included in computing the total settlement amount."

When a C&R settlement is entered into, typically there are no "previously settled portions" (at least in California). So, would one be prudent or required to use the previously paid Temp Disability & Perm Disability Advances, in addition to previously paid medical treatment to ascertain the low threshold for submitting a MSA to CMS?

Thank You,

California Attorney

Answer: Although your client was not Medicare entitled at the time of settlement, he was entitled when he received the settlement for surgical guarantee. Having said that, you will need to open a record with Medicare, using the surgery date as the date of incident and reimburse Medicare for any injury related claims they may have paid.