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Accident Claimants Should Make Sure Their Attorneys Reimburse Medicare If Necessary

A Medicare beneficiary who is treated for injuries and then sues to collect compensation is required by Federal law to notify Medicare of the claim. When the claim is settled the plaintiff must reimburse any payments made by Medicare for treatment of the injuries involved in the claim. Make sure your attorney complies with the law, because you may be liable to the government years after your claim is resolved if he or she fails to give to Medicare what’s due Medicare.

How to Resolve a Medicare Lien when Settling a Personal Injury Claim

First Step: Report Claim to the Coordination of Benefits Contractor for the Centers for Medicare and Medicaid Services

Your attorney must report the claim to the Coordination of Benefits Contractor for the Centers for Medicare and Medicaid Services (CMS). Contact information for the COB Contractor and the information to be provided to the contractor may be obtained at the CMS website, www.cms.hhs.gov.

Step Two: Request A Conditional Payment Letter

Your attorney should make a written request to the Medicare SecondaryPayer Recovery Contractor for CMS for a “conditional payment letter” showing any payments made by Medicare for the injury. Provide the Medicare Secondary Payer Recovery Contractor with the claimant’s name, address, date of birth, Medicare number, as well as the date and nature of injury.

Step Three: Audit The Conditional Payment Listing

Your lawyer should review the conditional payment letter sent by the Medicare Secondary Payer Recovery Contractor since it sometimes will list Medicare payments for medical treatment unrelated to the claim. Any conditional payments for unrelated treatment should be challenged, with documents evidencing the nature and extent of the claim injury provided.

Step Four: Provide Final Settlement Documents

Once your claim is settled, your attorney should provide the Medicare Secondary Payer Recovery Contractor with a copy of the settlement document and information on attorney fees and costs paid by the claimant (most injury cases are contingency cases). But Medicare is required to deduct a proportionate share of the fees and costs your attorney deducts from the award or settlement you receive. The Medicare Secondary Payer Recovery Contractor will prepare a final demand for payment letter showing the amount it claims Medicare is entitled to recover from the settlement.

Want more information? Go to www.cms.hhs.gov

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