In a mass tort case, can I challenge Medicare's lien if I am a Medicare beneficiary, but another insurer paid for my treatment?



If Medicare did not pay for any of your treatment, a process called "redetermination" can determine Medicare’s proper reimbursement amount. You must be able to show that you did not use your Medicare benefits. You can demonstrate that you are eligible for a redetermination if:

  1. Your Medicare coverage ended BEFORE you took the drug in question or your coverage began AFTER you settled your case; or
  2. You have another source of primary insurance coverage and can show that you had that other primary insurance coverage the entire time, from the date you took the drug in question through the date you settled your case.

If you fall into one of these two categories and are able to provide the documentation Medicare requires, the Medicare global reimbursement amount in your case will be reduced accordingly.