Medicare Part A, B, C and D plans all may have a right of recovery from a settlement, but they do not follow the same procedures for identifying and resolving potential reimbursement claims or liens. Additionally, beyond the different steps for the different Medicare plans, the type of case you have will also determine how the reimbursement process is handled.
Medicare liens are handled in different ways, depending on the type of case you have: an individual claim or a mass tort claim.
If you have an individual case, that means your attorney is only representing you for injuries you received, and NOT other people who were also injured in the same way, at the same time or because of the same medication or product. Examples of individual cases – or as we sometimes call them "single event" – include injuries from car accidents, falls on private property, nursing home cases, or even medical malpractice claims. After you and your attorney hire the Garretson Resolution Group, we resolve liens in these individual cases on a one-on-one basis with Medicare.
On the other hand, if your case is grouped with others who were injured by the same product or in the same way, you may be involved in what is known as a mass tort case.
What is a mass tort case? A mass tort case refers to a large number of lawsuits related to the same item or event that are grouped together. Often, these cases are brought before the same judge or before the same court in a particular region because they’re similar claims involving the same consumer product, prescription drug, or common event. These cases may involve hundreds or thousands of people with similar injuries throughout the country settling their cases on a mass or consolidated basis. For example, mass tort claims have involved the drug Vioxx, silicone breast implants, and diet drugs. Although there are many different people who claim that they were hurt or injured because of a specific product or medication, these people have all filed suit against the maker of the same product or drug.
While these claimants are all suing the same company and their lawsuits are grouped together – each person still has his/her own individual claim. That’s what makes a mass tort case unique. But the mass tort classification is important because it allows a small number of attorneys to represent many different plaintiffs with similar claims. In mass tort cases, your attorney may represent a number of people like you who allege they were injured in the same way, or by the same product or medication. Grouping the lawsuits allows attorneys to work together to investigate and/or defend claims and also allows the cases to proceed more quickly through the courts.
If you have a mass tort claim, your Medicare liens may be resolved under the same terms and at the same time as the other claimants that are part of your overall litigation. The liens are resolved as a group, and this is called global resolution. It means that the Garretson Resolution Group's team of medical experts will take a look at all the similar types of claims in your litigation and work to determine a fair, uniform, and efficient way of resolving everyone’s Medicare liens based upon the minimum standard of care and related medical expense associated with that care. In these global cases, Medicare will not open individual lien reimbursement files.
For instance, in a mass tort case there may be a large group of claimants who allege that they all suffered heart attacks because they all took a certain type of medication. For those plaintiffs, our medical experts would determine what the minimum standard of medical care would be for any person who was treated for a heart attack at the emergency room. The Garretson team would then determine the costs associated with that standard of care. That amount is then used as a global lien reimbursement value for every person who had that same injury in a specific mass tort. The advantage of this process is that it saves many many months in the process and produces fair and effective results.