Medicare Liens - Final Appeal Question

Question: I am looking for suggestions and input from those of you who have appealed Medicare final lien demands. I am about to put together our first one and I would be interested in knowing if there was any argument or perspective which was particularly successful in getting Medicare to back down off the lien number.

Also, if the appeal is unsuccessful, is the client liable for interest which accumulates during the appeal or is the interest suspended during the appeal period?

Thanks in advance,
New Jersey Attorney

Answer: Essentially there are three paths for administrative relief after a Final Demand. The circumstances of your client will typically drive which remedy should be pursued. The first remedy is an “appeal”. An appeal of a Final Demand amount is typically used in situations where Medicare has included unrelated charges in the final claims pull or where the procurement offset has been incorrectly calculated. The second type of remedy is a “compromise” request. The grounds for a compromise would typically be that the distribution of the settlement proceeds would be inequitable to the plaintiff. The third remedy is a “waiver”. Typically a waiver request is used in situations where the repayment of Medicare will create a financial hardship for the plaintiff or the plaintiff’s dependent(s) (if the plaintiff is deceased). Often times obtaining a favorable result after Final Demand hinges on pursuing the most applicable remedy.

On your interest question, interest will continue to accrue during any post-Final Demand appeal. However, if Medicare finds in favor of your client (fully or partially), they will waive the interest tied to that waiver. We usually recommend paying the Final Demand during any appeal, but that could depend on your unique situation.

I hope this helps.