Medicare Liens

Under Medicare law, if a Medicare beneficiary is involved in a lawsuit, the liability insurance, no-fault insurance, and workers’ compensation must pay for the beneficiary’s medical services/items before Medicare pays. Attorneys, along with their clients, are responsible for ensuring compliance and must make every effort to inform Medicare of any primary payer that may be responsible for the client’s injury-related medical expenses.

The Medicare Secondary Payer (MSP) Program

According to the Social Security Act, Medicare is considered a secondary payer for a beneficiary’s medical expenses when payment “has been made or can reasonably be expected to be made under a workers’ compensation plan, an automobile or liability insurance policy/plan, or under no-fault insurance.”

In cases where medical expenses are in dispute and the primary insurance does not pay for the services, Medicare will act as the primary payer conditionally. This means that Medicare is subject to recovery of the expenses pending your client’s settlement, judgment, or award. Medicare will seek recovery of funds from the client, the primary plan/entity, physician, and even the client’s attorney through medicare lien resolution.

Reimbursing Medicare

The Benefits Coordination & Recovery Center (BCRC) is responsible for the recovery, management, and reporting of mistaken liability, no-fault, and workers’ compensation claims where the beneficiary must repay Medicare. When a case ends and the beneficiary receives an award or settlement, the BCRC issues a formal demand letter advising the beneficiary and his attorney of its primary payment responsibility.

How Synergy Can Help You and Your Clients

We know how complicated and time-consuming the entire medicare lien process can be. This is why we provide attorneys and their clients with a healthcare lien resolution service to relieve them of the hassles of this complex process. We have experience handling all types of pre/post settlement lien verification and resolution issues. We’ve assisted countless attorneys with lien negotiations and have consistently achieved favorable outcomes on their clients’ behalf. Let us save you time, lower your operational costs, and leave a lasting impression on your clients.

For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.

Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.

TESTIMONIALS

"I recently engaged Synergy to assist with a complicated PTD settlement involving a substantial Medicare Set Aside. The claimant’s wife has been providing full time attendant care which is not Medicare covered. The Synergy nurse was able to do a full analysis of non-Medicare covered expenses which far exceeded the value of the MSA analysis performed by the carrier’s contracted MSA provider. The non- Medicare figures became the main focus of the settlement negotiations and more than doubled the value of the case. Although I could estimate the attendant care figures, the nurse added in other items that I would not have routinely considered. I also asked Synergy to evaluate the EC’s MSA as well as their prescription review. Synergy offered insight about the prescription donut hole which I did not have a clear understanding about. Again, their insight and information added a great deal of value to the overall settlement. Not only did I learn from Synergy but was able to educate my clients in the process. These are very complex and complicated areas; I will use Synergy again and again!"

Rosemary Eure
Lancaster & Eure

"Whenever I have turned to Synergy, their team has always been there for our firm and our clients. They always take the time to answer all our clients’ questions and provide quick, accurate and reliable information so they can make an informed decision regarding structured settlements. With Synergy on our side, we know that our clients are getting the best service and the best structured settlements."

Troy Rafferty
Levin, Papantonio, Thomas, Mitchell, Echsner & Proctor

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