Payment Can Be Elusive For Medicare Beneficiaries In Personal Injury Cases | WAMU 88.5 - American University Radio

NPR : News

Filed Under:

Payment Can Be Elusive For Medicare Beneficiaries In Personal Injury Cases

Medicare beneficiaries who win a settlement in a personal injury liability case sometimes find their efforts are for naught because the federal Centers for Medicare and Medicaid Services ends up getting the money they thought would be theirs.

A new law is expected to fix problems with the system so seniors can get what's coming to them.

The snafus arise in what's called the Medicare Secondary Payer process. If there's a settlement or judgment against another party in a liability case, Medicare is entitled to reimbursement for the money it spent on a beneficiary's medical care. It becomes the "secondary payer" while the liability insurer or other responsible party becomes the "primary payer."

But to collect, Medicare has to tally up and report how much it's owed. And that process is fraught, say lawyers for victims and defendants alike.

It's not all that unusual for there to be a discrepancy between Medicare's initial and final reimbursement demand, says Magruder.

In one case following a car accident, for example, Medicare initially said it believed it was owed $1,000, says Linda Magruder, a plaintiff's lawyer in Louisville, Ky. The insurance settlement was $25,000, and the money sat in an escrow account awaiting Medicare's final tally of how much it was owed. A year later, the answer arrived: $30,000.

Under the new law, dubbed the Strengthening Medicare and Repaying Taxpayers Act, such surprises should be history.

Among other things, the law sets deadlines for Medicare to post how much it's owed on a Web portal that's accessible to litigants. The new law:

  • requires Medicare, as part of the settlement process, to post any medical payments it makes to providers within 15 days;
  • requires Medicare beneficiaries to notify the agency within 120 days of an expected settlement, at which point the agency has 65 days to post what it's owed. If necessary, the agency can request an additional 30 days;
  • gives the agency 11 days to respond if a beneficiary disputes how much Medicare is owed; and
  • limits Medicare repayment demands to three years from the date that an anticipated settlement is reported.

For its part, Medicare says it's committed to doing a good job.

"CMS's goal is a Medicare Secondary Payer program that operates at the highest level of customer service," said Deborah Taylor, director of the CMS Office of Financial Management, in a statement. "We have made numerous improvements that not only improve efficiency in the program but also protect the interests of beneficiaries and the Medicare Trust Fund."

Copyright 2013 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.

WAMU 88.5

Art Beat With Lauren Landau, Jan. 27, 2015

You can see a play about a girl whose world shifts from black and white to full color. An exhibit of abstract paintings is on view in D.C.

NPR

Beef Packers Block Plan To Revive Growth-Promoting Drug

Beef processors continue to block efforts to bring back Zilmax, a drug that makes cattle put on weight faster. Is it because they're concerned about animal welfare, or beef exports?
NPR

Obama Makes Guest Appearance On Modi's Radio Show

India's Prime Minister Narendra Modi hosts a radio show and this week his guest was President Barack Obama. They answered questions from a curious Indian public.
NPR

Facebook Suffers Self-Inflicted Outage

A Facebook statement said the disruption was caused by a technical change it made to the site and wasn't a cyberattack. The outage lasted an hour.

Leave a Comment

Help keep the conversation civil. Please refer to our Terms of Use and Code of Conduct before posting your comments.