Medicare Secondary Payer Reimbursement Procedures After Haro v. Sebelius

A recent decision by the United States District Court for the District of Arizona provides guidance on the collection practices and procedures utilized by the Centers for Medicare and Medicaid Services (“CMS”) under the Medicare Secondary Payer (“MSP”) statute (42 U.S.C. § 1395y(b)(2)). In granting summary judgment in favor of the Plaintiffs, the Court opined that CMS collection practices were not in accordance with the statutory scheme created by Congress for the MSP program. This decision challenges Medicare’s current reimbursement claim recovery process for disputed claims.

The Garretson Resolution Group (“GRG”) specializes in settling health care liens and reimbursement claims with federal (Medicare), state (Medicaid) and private/ERISA health insurance providers in single event and mass tort settlements. In fact, GRG evaluated and resolved Medicare and Medicaid’s interest in over 50,000 cases last year alone. Simply put, we know the process.

This practice tip provides a synopsis of Haro v. Sebelius and describes the impact this decision may have on the MSP reimbursement process and tort settlements going forward.

Among the tips included in this pamphlet are:

  • What are the key takeaways from Haro v. Sebelius?
  • How does this decision impact the collection practices and procedures utilized by CMS under the MSP statute?
  • May CMS preclude plaintiff attorneys from disbursing undisputed portions of settlement proceeds to their Medicare entitled clients?