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Colorado Accident & Injury Law Part III cont. Medicare Liens

May 28, 2009 by The Sawaya Law Firm

2. Medicare:

  • Medicare is a federal government healthcare program for those over 65 or those under 65 who are disabled, suffering from permanent kidney failure or diagnosed with Lou Gehrig’s disease.
  • Medicare has a statutory lien for any medical bills it has paid that are accident related. Resolving the liens takes time, as the federal government has a private contractor handling the resolution of the liens.
  • Two current problems with Medicare.
  • (1) Federal Medicare law requires that, in the event there will be future accident related medical bills, a set-aside for future medical bills be provided.
  • However, no procedure has yet been designated by the federal government to formalize this requirement. Yet, it is expected that this be accomplished in personal injury settlements.
  • Medicare can refuse to pay for future medical bills if Medicare asserts that a portion of a settlement specifically provided for future medical bills.
  • Merely refraining from designating any of a settlement or resolution as providing for future medical bills is not likely to be sufficient to preclude a review and assessment by Medicare. It is a matter of a good faith and a reasonable standard.
  • This should give any Plaintiffs’ attorney pause, especially when settling any case of substance where the client is either on Medicare or likely to be on Medicare within the next thirty months.
  • There are attorneys specializing in the area of Medicare and Medicaid liens. It is sound practice to, at least, seek the advice of such specialists when a Medicare future medical issue is present in the case.

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