the two-way street to medicare compliance

Lessons from the Court Room

Recent court decisions in Nebraska and Connecticut highlight an emerging trend in Medicare Secondary Payer (“MSP”) Act compliance for reporting purposes. Insurance carriers and self-insureds may face steep penalties for failing to report certain information about settlements, awards, judgments or other payments that involve a Medicare beneficiary under Section 111 of the MMSEA (42 U.S.C. § 1395(b)(8)). But the process is not a one-way street.

The Garretson Resolution Group (“GRG”) provides this practice tip to help our clients navigate the evolving standards impacting tort settlements and lien resolution. We will continue to investigate and report on any similar developments involving MSP Act compliance.

Among the tips included in this pamphlet are:

  • What is the significance of Seger v. Tank Connection and its progeny, Hackley v. Garofano, in regard to reporting requirements under the MMSEA?
  • How do these decisions reinforce the right of a defendant insurer to compel provision of a plaintiff’s SSN and/or Health Insurance Claim Number in order to comply with the mandatory insurer reporting required by § 111 of the MMSEA?
  • What are the policy reasons behind allowing insurers to condition disbursement of settlement funds on the plaintiff’s disclosure of their SSN and/or Health Insurance Claim Number?