Settling Medicare Liens in Personal Injury Cases

by Sacramento Personal Injury Lawyer Noah Schwinghamer

When someone files a personal injury lawsuit in California, and Medicare has paid for some of the plaintiff’s medical bills, the plaintiff has an obligation to notify Medicare, and possibly pay back the money that Medicare paid.

What is Medicare?

Medicare is basically government funded health insurance for people 65 and older, people with end state renal failure, people with certain disabilities, and people who have received SSDI (Social Security Disability Insurance) for the past 24 months.

What Are a Plaintiff’s Obligations When Filing a Personal Injury Lawsuit?

1.  Notify the Medicare Coordination of Benefits Contractor (COBC) of the plaintiff’s accident. 

[Medicare’s Page: Reporting a Case]

Include the following information:

  • Beneficiary’s Name
  • Beneficiary’s Health Insurance Claim Number (HICN)
  • Beneficiary’s Gender and Date of Birth
  • Beneficiary’s Address and Phone number
  • Date of injury/accident, date of first exposure, ingestion or, implant.
  • Description of alleged injury or illness or harm.
  • Type of Claim (Liability insurance, No-Fault insurance, Workers’ Compensation).
  • Insurer/Workers’ Compensation name and address.
  • Representative/attorney name
  • Law Firm name if the representative is an attorney
  • Address and phone number

How to Contact the COBC:

By Telephone
(855) 798-2627


By Mail -General Inquiries
MEDICARE–BCRC

P.O. Box 138897

Oklahoma City, OK 73113

By Fax

(405) 869-3307

 

2.  MSPRC will issue a “Rights and Responsibilities Letter.”

This confirms that MSPRC has opened a case.

Basically this letter explains that Medicare will make up-front payments for your medical care, but Medicare expects to get paid back from any lawsuit, claim, or worker’s compensation benefits you get.  The up-front payments are called “Conditional Payments.”

[Example of a Rights and Responsibilities Letter]

3.  Send Consent to Release or Proof of Representation.

If a medicare beneficiary wishes to allow Medicare to disclose information to someone else, they need to send MSPRC either (1) a Consent to Release or (2) Proof of Representation.

Consent to Release – Allows medicare to disclose certain information for a limited amount of time.  [Click here for Consent to Release Model Language]

Proof of Representation – Allows the Representative to act on the beneficiary’s behalf.  This is the option attorneys should use.  Attorneys can show a proof of representation one of two ways:

  • Option 1 – Send a copy of the retainer agreement, signed by attorney and beneficiary, with the beneficiary’s name and Health Insurance Claim Number (HICN) printed at the top of every page.  Include a cover letter on the attorney’s letterhead.
  • Option 2 – Have the beneficiary sign a Proof of Representation Document.[Click Here for Proof of Representation Model Language]

These documents may be sent to:

By Mail

MSPRC – NGHP
PO Box 138832
Oklahoma City, OK 73113

By Fax

(405) 829-3309

4.  Medicare Will Send Out a Conditional Payment Letter.

This letter should say how money Medicare has paid.  Remember, Medicare calls this money “conditional payments.”

[Example of a Conditional Payment Letter]

5.  Send Medicare Final Settlement Details

Medicare needs the following information before it can finally close out a case:

  • Total Amount of the Settlement
  • Total Amount of Med-Pay or PIP
  • Attorney Fees
  • Itemized List of Expenses
  • Date the Case Was Settled

Medicare has a standard from you can use called a Final Settlement Detail.  [Final Settlement Detail]

This information may be sent to:

By Mail

MSPRC – NGHP
PO Box 138832
Oklahoma City, OK 73113

By Fax

(405) 829-3309

 


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