medicare's name on the check

Not a Shortcut to Medicare Compliance

According to a recent Pennsylvania Superior Court case, Zaleppa v. Seiwell, the inclusion of Medicare on a settlement check is contrary to Pennsylvania common law and federal statutory law. The Court in Zaleppa reasoned that including Medicare on a draft stands in the way of satisfying a judgment. Additionally, the Court made clear that a private entity may not assert a reimbursement right on behalf of the United States government. This ruling provides considerable clarification and guidance pertaining to Medicare’s federal reimbursement rights.

The Garretson Resolution Group (“GRG”) provides this practice tip as part of our commitment to monitor and report recent developments impacting tort settlements and lien resolution. 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.

Among the tips included in this pamphlet are:

  • How does the Zaleppa decision clarify Medicare’s federal reimbursement rights?
  • Does the MSP Act allow a private entity to assert the rights of the U.S. government regarding potential claims for reimbursement of a Medicare lien?
  • What practical guidance does Zaleppa provide with respect to the relative roles parties must play in order to ensure Medicare’s reimbursement rights are properly identified, resolved, and satisfied?
  • How does the Zeleppa decision fit within current Medicare compliance solutions?