Federal law requires that Medicare be notified, and sometimes reimbursed, when a Medicare recipient receives a personal injury settlement. This creates many questions that Doran and Murphy attorney Colleen Murphy tries to answer for you:

“Why is Medicare entitled to some of my money?”

This is the question that I hear and answer almost daily. You (or your loved one) worked hard for decades, with the promise that the United States Government would take care of you when you retired – through retirement benefits and health insurance in the form of Medicare. Why should the government be allowed to meddle in your personal injury lawsuit and take some of your money? The answer is simple – and complicated.

The simple part of the answer is that the railroad hurt you by exposing you to toxic substances like asbestos and diesel exhaust. Those exposures caused you to suffer from diseases such as COPD, mesothelioma and other types of cancers. The government, through Medicare, paid for your medical treatment, at least in part. In essence, the railroad hurt you, and the railroad hurt the government. I usually ask people this – why should your neighbor have to pay (through taxes) for your medical treatment for a condition that was caused by the railroad’s negligence? The answer is that they shouldn’t. It’s not fair. Part of a verdict, or settlement, often times needs to go back to the government to pay it back for your medical care.

The complicated part of the answer is that reimbursement is required by law. There is a law called the Medicare Secondary Payer Act. This law basically puts into effect the reasoning put forth above – the Government is tired of paying for medical care for injuries and diseases that were caused by some one’s (or some company’s) negligence. The law requires that Medicare’s financial interests be considered when an injured person sues a negligent party for injuries that Medicare paid for.

“Why Does Medicare Take So Long? I’m giving them money, isn’t there an incentive for them to get their money as fast as possible?”

Many Medicare beneficiaries will tell you that Medicare takes seemingly forever to process claims. The claims process at Medicare is set up with several steps, including analyzing the claims made in the lawsuit and comparing those claims to the bills submitted by your medical providers to Medicare. We work with some of the country’s greatest consultants to make sure that all of Medicare’s claimed medical treatment is related to your lawsuit, and we dispute any claims that are unrelated. Finally, if your case goes to trial, the Medicare claims are submitted into evidence for the jury to use in deciding the case. If your case settles, we will use the Medicare claims in negotiating. Once we have a verdict or settlement, this information is sent to Medicare, and they send us a Final Demand for Payment. We can’t distribute your money or our fee until we get this Final Demand for Payment.

A couple of years ago, so many people started complying with the law that there was a logjam of claims. Medicare was unprepared, and the claims sat in Medicare’s system. The good news is that Medicare is getting better. They are constantly trying to improve their process to make it more streamlined and faster.

All in all, this process still takes some time, but the sooner it starts, the sooner it will be finished. If you get any paperwork from your attorney requesting information or signatures for Medicare, responding as soon as possible will help speed up your claim.

“Medicare Paid A Lot Of Money For My Medical Treatment – Should I Still Pursue a Claim, Or Will Medicare Get All of the Money?”

Call us. There are many options for cases like these, including compromises with Medicare (where Medicare agrees to take a smaller percentage of what they are entitled to) and waivers (where Medicare agrees that it would be in the interests of fairness to waive their claim). There are also provisions of the law that exclude certain people from having to pay money back to Medicare, such as those people whose exposure was all before December 5, 1980.

Our job is to maximize your recovery, while protecting you from future claims from these insurers. The rules surrounding Medicare can be confusing, but don’t let them stop you from making a claim. We are here to help you with every aspect of your claim, including lien resolution. If you have a question, just give us a call.