Alabama Workers' Comp Blawg

  • 27
  • Jan
  • 2010

MEDICARE TAKING AGGRESSIVE STAND ON RECOVERY OF CONDITIONAL PAYMENTS

In December of 2009, Medicare filed a lawsuit in the U.S. District Court for the Northern District of Alabama seeking to recover conditional payments it made to medical providers on behalf of the plaintiffs involved in a $300 million global settlement. The lawsuit cites Medicare Secondary Payer provisions in federal law that allow Medicare to recover past and future medical expenses from all parties, insured and self-insured, involved in a liability claims award or settlement that includes Medicare eligible individuals.

The settlement was entered into in 2003. By filing the lawsuit some 7 years later, Medicare is indicating that it is willing to reach back and go after any medical costs it considers owed. Of interest, is that Medicare simultaneously named insurers, settlement beneficiaries and plaintiffs attorneys in one lawsuit. This means that if Medicare’s interests are not considered, all parties to a settlement are left exposed to an action for recovery by Medicare.

My Two Cents:

At this point, Medicare appears to only be focusing on the big multiparty settlements where it stands to recover at least seven figures. However, you cannot ignore the fact that Medicare may have the resources and manpower to pursue the smaller settlements several years down the road. With the new mandatory reporting requirements in place, we are now all on Medicare’s radar!

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