Identifying Medicare and Medicaid Liens: Essential Tasks in Settling Your Case

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The Personal Injury Attorneys at Collins & Collins, P.C. understand that Medicare and Medicaid (hereinafter collectively referred to as Medicare) liens are serious business.   Failure to address these in a sensible manner can have severe financial consequences on parties to a personal injury lawsuit.

The question our clients have once they understand the duty to satisfy Medicare liens is what they can do to protect themselves from future liens while maximizing their financial recovery from a personal injury lawsuit.

The first step a personal injury attorney should take is to identify all government benefits that the client is receiving.  This would include not only Medicare and Medicaid, but also any Social Security benefits including disability and income benefits.  To protect your financial interests, and to insure that all of these benefits are properly accounted for and considered in the resolution of your claims, you should make sure your attorney is aware of all these benefits.

Negotiating with Medicare

Once your attorney is aware of these possible liens, you will need to provide a HIPAA and a Standard Consent to Contact Form.   This will allow you attorney to directly deal with Centers for Medicare and Medicaid Services (CMS) and the Social Security Administration (SSA).  Your attorney will then be able to collect all necessary documentation related to any liens the government will be asserting against your personal injury claims.

CMS and SSA will then respond to your attorney within a few weeks identifying the benefits that you have received.  Once this is done, then your attorney will have a map of all possible liens that must be negotiated and settled at the conclusion of your lawsuit.    Both you and your lawyer will now know who must be contacted to insure that all possible government liens are addressed.

Your attorney will then make several contact with a couple of offices to get the process started toward resolution of your liens.  Since October 2006, the Medicare has centralized its lien recovery in the Medicare Secondary Payer Recovery Center (MSPRC) in Detroit, Michigan.   To get a case going, the initial contact by your attorney will be with the Medicare Coordination of Benefits Contract Center.  The attorney will notify COBC of the pending litigation along with information on you and your claims.  Once this is done, the case is assigned to MSPRC to whom all future correspondence will be directed.

MSPRC will be notified of all personal injuries related to the litigation.  Medicare has liens only against treatment for these injuries.  Other Medicare related medical benefits do not carry a lien against your personal  injury recovery.  Treatment prior to your personal injuries, and treatment subsequent to your personal injuries, but unrelated to those injuries are not subject to lien.  Therefore, it is important to document with MSPRC the injuries for which you are seeking recovery.

Once the file is open with MSPRC, your attorney will then submit a HIPAA release which allows the attorney to collect all your Medicare related records.   The file can remain open for quite some time.  Resolution of personal injury claims can be slow.  The primary consideration is medical treatment.  Resolution of personal injury claims prior to completion of medical treatment will waive all future medical treatment for those injuries.  In other words, the insurance company will require that you sign a release of claims including future medical treatment and even undiscovered injuries in return for settlement of your claims.  Because personal injuries suffered in an accident can be very serious, treatment of those injuries often takes a long time, sometimes years.  Resolution of a claim before treatment is complete can be disastrous resulting in life-long unresolved injuries, and future medical expenses on those injuries.

Once the Medicare file is open.  Your attorney will occasionally be contacted by Medicare for a status report on the claims.  The attorney will inform Medicare of the status of the case.  Once the case settles or goes to trial, the attorney will contact Medicare to let them know of the settlement.  As settlement or trial nears, the attorney will get updated Medicare records for a precise determination of outstanding liens.

Calculation of these liens is important in the valuation of both settlement and trial value.  It is important for you to know the amount of these liens since it would be impossible to evaluate a settlement without knowing the liens.  After all, the liens are paid out of any recovery.

Once the case settles, or as settlement approaches, the real work begins.  Your attorney should work hard to negotiate down your liens.  Medicare will often agree to a significant reduction of its liens.  In addition, because Medicare has no way of knowing exactly what treatment was related to your personal injuries, the lien will often include unrelated medical expenses.  Medicare is good about recognizing these unrelated expenses once they are made aware of them.  Going through the liens item by item can result in substantial lien reduction.  Lien negotiation will be the topic of the next article on Medicare liens.

If you have a personal injury claim and you have received Medicare benefits in your personal injury related treatment, contact the Personal Injury Attorneys at Collins & Collins, P.C.   We will gladly discuss the process of identifying your Medicare  liens with you.   You can reach us by phone at (505) 242-5958.  For more information on our firm and other questions you might have, you can visit us at www.CollinsAttorneys.com.

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