Having trouble getting Medicare to reduce a lien? We can guide you through the process!

Question: “I have a client with severe injuries. Medicare has demanded nearly her entire net distribution (after reduced attorney’s fee and costs), which will leave my client with no money, but outstanding liens and co-pays. Medicare denied the waiver application, and an agent told me it will not take into account my client’s Department of Public Welfare Lien, HealthCare Recoveries lien and outstanding co-pays. Can Medicare really take my client’s entire net settlement and leave her with debt?”

Answer: The Medicare Secondary Payer (MSP) Act (42 U.S.C. Sec. 1395y(b)(2)) provides the federal government with a priority right of recovery for any conditional payments made. In the past, you may have (incorrectly) heard this referred to as a “Superlien”. In short, the Medicare Trust Fund has a right under federal law to be reimbursed before other lien holders. Further, Medicare’s right of recovery is complete, meaning that it has a right to be reimbursed up to 100 cents on the dollar for any conditional payments made. It does not have to take into account the fact that other providers may have also paid for a claimant’s past medical expenses.

From time to time, this priority right of recovery, if asserted to its fullest possible extent, may lead to unfair and inequitable results for the claimant. In such cases, the claimant has the ability to appeal decisions through a series of levels within the agency itself. Once those five levels of appeals have been exhausted, the claimant then has standing to file in federal court in an effort to obtain a fair and equitable result.

One of the ways that GRG has been successful in preserving the claimant’s rights in the past is to request a pre-settlement compromise or waiver by Medicare of any rights of recovery based on the case specific facts. While no means is such a compromise or waiver a guaranteed result, asserting arguments based on equity and starting the recovery process early on tend to increase one’s chance of success. We would be happy to speak further with you about what options still exist in your case and how GRG may be able to maximize your client’s net recovery at this point.