Piatt Consulting ~ Information for Attorneys

Settling a mass tort with Medicare and protecting the settlement from invalid recovery is poorly understood and practiced by most claims adjustors, third-party administrators and court-appointed special masters.

In Fanning, et al. v. AcroMed Corporation, et al., "… a second offset will be applied to the net distribution of all remaining claimants…", to cover the deficit of funds available to a "… subgroup of persons consisting of those who identified themselves as having a Medicare (or other government program) number, even though a substantial number of them apparently have no spine-related Medicare services associated with

their files."

Medicare has a direct right of recovery from those that receive payment (e.g.,

a liability insurer or self-insured business entity) to an individual and the common funds and trusts designed to manage the distribution of those funds. Importantly, they also have a direct right of recovery from those that receive proceeds of payment from a primary plan to a beneficiary.

If you were paid from the proceeds of the settlement, you can be forced to pay the entire amount of the settlement from your own pocket.

Dealing with Medicare mass tort reimbursement requires special knowledge and negotiating skills to protect you and your claimants. Engage Medicare Consul Liens to negotiate the Medicare reimbursement and protect the interests of entire class.

PROTECTING YOUR CLIENT AND MEDICARE’S INTEREST IN THE FUTURE MEDICALS

Your client is clearly responsible for properly expending the funds (See CFR § 411.43); however, insurers and self-insured companies may insist these funds be protected. Protect your client and satisfy the insurer, by providing your client with Medicare Consul Liens’ patent pending Future Medicals Card.

ADMINISTER THE FUNDS USING THE FUTURE MEDICALS CARD

Medicare Consul Liens is the first company to license and offer the patent pending Future Medicals Card to the Medicare community. Contact us to establish a restricted transactional account of specifically identifiable funds accessed by our Future Medicals Card. In conjunction with our nationally recognized, FDIC bank and global payment processing network the Future Medicals Card restricts your clients’ purchases.

Medicare’s new Mandatory Insurer Reporting law need not have a deleterious effect on settlement. If you haven’t settled a case for a Medicare beneficiary recently, you may find that insurers have become almost intractable in the efforts to placate Medicare and protect their interest.

Before you agree to represent your client and report the potential settlement to Medicare, is the case worth pursuing?

Collect your client’s medical bills

Will you be dealing with reimbursing Medicare or facing a lien from a provider(s)?

The provider must withdraw a claim with the liability insurer and/or withdraw its lien against a potential settlement if:

If they file a claim with the liability insurer or lien against the liability settlement and the case doesn’t settle within 120 days or If they bill Medicare, the case must settle within 120 days, or the provider must withdraw the claim with the liability insurer and/or withdraw its lien against a potential settlement. With the new Patient Protection and Affordable Health Care Act, the time providers have to submit a bill to Medicare has been reduced from 3 years to 1 year.

If there is still time, it might be faster to deal with the provider’s lien, but you will pay a premium. Medicare only pays 80% of usual and customary for your geographic location.

If your client’s providers have billed Medicare, your next step is to determine how much they billed. Collecting your client’s bills is a good start, but unfortunately you will not be able to be sure they reflect Medicare’s understanding of the damages until your receive the Conditional Payment Letter.