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Can Medicare Take My Settlement?

Dan Brian   |  December 13, 2018   |  

Once you obtain a fair settlement from an insurance company, you may think the battle has ended. Even after you secure the compensation you need to pay for medical bills and property repairs; your legal journey may not be over. You may still have to deal with repaying awards and benefits you received as a Medicare recipient. If you forget to repay these amounts, Medicare has a lien and claim against your settlement funds and is entitled to payment. Here’s what you need to know after settling your case as a Medicare policyholder.

How Does Medicare Pay for Injuries?

Directly after an accident that requires medical treatment, you must report what happened to the Medicare Coordination of Benefits (COB) Contractor, if you are a Medicare recipient. Federal law requires immediate reporting. The Contractor will need a description of your injuries, names of your healthcare providers, and your lawyer’s information if you have hired one. The COB Contractor will process your report and oversee the reimbursement of Medicare benefits. Failing to report your accident could result in the elimination of your Medicare eligibility.

After you report what happened, an agent for Medicare will continue to monitor your case, periodically requesting case updates from you or your attorney. Once you obtain a settlement for your personal injuries, federal law requires that you or your lawyer notify the COB Contractor of successful claim resolution. Notification must occur before anyone distributes the settlement proceeds to you, the claimant. At this point, the COB Contractor will send you a write-up of all medical treatment expenses Medicare paid on your behalf. Medicare will expect reimbursement for these costs.  We handle all of these issues for our clients and we begin this process as soon as we learn that our client is on Medicare through the age or disability eligibility requirements.

You do not have the option to negotiate with Medicare for the amount you owe. You legally must give back all the money Medicare paid toward your medical bills, in the amount invoiced to you by the COB Contractor. However, as your attorneys, we are allowed by law to reduce the amount reimbursed to Medicare for its fair portion of attorney fees on your case.  Only in the rarest of circumstances will federal law permit a COB Contractor to accept a different, negotiated lien amount. We have handled some of these rare circumstances and won for our clients.  Talk to your lawyer about your specific case, but most claimants should assume reducing the lien amount is not possible. Instead, you must pay Medicare back in full for the amounts it spent on your medical care.  Again, we have handled some of the exceptions to this rule.

How to Reimburse Medicare With Your Settlement Money

When the COB Contractor mails you an invoice of all medical costs you supposedly owe Medicare upon receiving your settlement, you and your lawyer will have the chance to review the charges and verify that they are accurate. If they are correct, your lawyer will allot a portion of your settlement award in the appropriate amount to the COB Contractor in the form of a check. Only after your settlement fully reimburses what you owe Medicare for medical treatment may you keep what’s left of the award.

If you or your attorney notice something amiss with the COB Contractor invoice, such as an old medical expense unrelated to your recent accident, you must give notice to the Contractor of the mistake. The Contractor will review the situation and determine whether to change the invoice. If it agrees with you, it will send an invoice for the new, corrected amount. This process could take a couple of months.   We routinely find mistakes on our clients’ Medicare bills and we usually win these battles for our clients by having Medicare remove unrelated charges.  When Medicare refuses, we appeal to the next level and we have even taken our appeals to Administrative Law Judges in order to win relief for our clients. We have been very successful at winning for our clients.

You will have the opportunity to appeal the COB Contractor’s decision if the Contractor disagrees that the invoice has a mistake. You will have to fulfill the Medicare internal appeals process, during which you cannot access your personal injury settlement award. You can only receive your portion of the settlement after finishing all matters related to Medicare bills.  While we are fighting Medicare during the appeal process we usually pay Medicare the final amount it demands to avoid penalties and interest.  We will get reimbursed for every penny once we win at the appeals level.  Since these cases can be very complex, it’s generally in your best interest to hire an attorney. An injury attorney in Raleigh can help you protect your rights after winning a settlement.  We have handled many of these Medicare issues and are ready and willing to help you.