Medicare Lien Update for 7/1/09 SCHIP Extension Act Reporting
With the SCHIP Extension Act reporting requirements scheduled for implementation on July 1, 2009 for liability, self-insurance, workers’ compensation and no-fault insurance, the Attorneys at Burns White want you to be well-equipped for lien resolution. While the SCHIP Act will serve to identify and clarify lien matters, you should be aware of Medicare’s lien authority under the Medicare Secondary Payer laws, pursuant to 42 USC 1395y(b).
The Medicare Secondary Payer laws assert rights to reimbursement for conditional payments Medicare might have made related to a workers’ compensation or liability injury. In an effort to identify pre-settlement liens, Burns White requests a Medicare Lien Verification Statement, which serves as an estimate of cost accrued to date that are reimbursable to Medicare from the settlement proceeds. A final, post-settlement Medicare Lien Verification Statement and Formal Demand is then obtained after final settlement occurs. Often times, Medicare Lien Verification Statements include payments made by Medicare that are not related to the litigation, expenses that may have already been paid by the carrier, or costs for which repayment is not feasible otherwise. Medicare has established procedures for challenging payments that appear on Medicare Lien Verification Statements. If you receive a Medicare Lien Verification Statement with charges that should not or will not be reimbursed to Medicare, you have the rights to the following:
The Medicare attorneys at Burns White are proficient in providing Medicare conditional payment legal services, including obtaining a Medicare Lien Verification Statement and negotiating, requesting waiver for, or appealing any conditional payments Medicare might have made. It is important to keep in mind that satisfying Medicare liens is a crucial part of performing the obligations set forth by the Medicare Secondary Payer laws. If Medicare lien issues are not resolved in a timely manner, the following might apply:
If you wish to learn more about Burns White’s Medicare Lien identification and resolution services, or if you are interested in further lien education in this regard, please contact Bruce McKnight at bemcknight@burnswhite.com or (412) 995-3247.
The Medicare Secondary Payer laws assert rights to reimbursement for conditional payments Medicare might have made related to a workers’ compensation or liability injury. In an effort to identify pre-settlement liens, Burns White requests a Medicare Lien Verification Statement, which serves as an estimate of cost accrued to date that are reimbursable to Medicare from the settlement proceeds. A final, post-settlement Medicare Lien Verification Statement and Formal Demand is then obtained after final settlement occurs. Often times, Medicare Lien Verification Statements include payments made by Medicare that are not related to the litigation, expenses that may have already been paid by the carrier, or costs for which repayment is not feasible otherwise. Medicare has established procedures for challenging payments that appear on Medicare Lien Verification Statements. If you receive a Medicare Lien Verification Statement with charges that should not or will not be reimbursed to Medicare, you have the rights to the following:
- 1. The Right to Appeal: If the parties disagree that Medicare is owed, or if the parties disagree on the amount of the conditional payment, an appeal can be filed by sending a letter to Medicare explaining to Medicare why the amount requested is incorrect and/or any reason(s) why the amount is contended. Appeals must be filed within one-hundred and twenty (120) days of the date of the Lien Verification. Medicare will assume that receipt occurred five (5) days from the date of the letter, unless proof is furnished otherwise.
- 2. Requesting a Waiver: Parties have the right to request that Medicare waive recovery of the amount owed in full or in part. The amount the waiver is requested for is referred to as an “overpayment” by Medicare. The waiver procedure is different from a request for reconsideration or a formal appeal, although requests for waiver and appeals may be concurrent. Medicare may waive recovery of the amount due if the following conditions are met:
a. Any “overpayments” for which a request for waiver is made was not the fault of the Claimant, and the Claimant thought the correct payment was being made;
AND
b. Reimbursing this money to Medicare would cause financial hardship OR would be unfair for some other reason
The Medicare attorneys at Burns White are proficient in providing Medicare conditional payment legal services, including obtaining a Medicare Lien Verification Statement and negotiating, requesting waiver for, or appealing any conditional payments Medicare might have made. It is important to keep in mind that satisfying Medicare liens is a crucial part of performing the obligations set forth by the Medicare Secondary Payer laws. If Medicare lien issues are not resolved in a timely manner, the following might apply:
- The parties might be required to pay interest on any remaining balance if payment is not made within Medicare’s deadlines.
- If Medicare liens are not repaid in full, Medicare can recover any amounts owed, including any accrued interest, from a Claimant’s Social Security or Railroad Retirement benefits, or from any future Medicare payments.
- Failure to make repayment or to request one of the above courses of action within a timely manner could result in Medicare’s initiation of additional recovery procedures without further notice. Actions Medicare might take include referral to the Department of Justice for legal action and/or the Department of the Treasury for collection actions. (The Treasury Department could seek double damages at this point).
- The Debt Collection Improvement Act of 1996 requires federal agencies such as Medicare to refer debts to the Department of the Treasury or its designated debt collection center for recovery actions including collection by offset against any monies otherwise payable to debtor by any agency of the United States. Under this and other authorities (31 U.S.C. §3720A), the Internal Revenue Service may collect this debt by offset against income tax refunds owed to individuals or other entities.
If you wish to learn more about Burns White’s Medicare Lien identification and resolution services, or if you are interested in further lien education in this regard, please contact Bruce McKnight at bemcknight@burnswhite.com or (412) 995-3247.
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