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Defendant payors must take Medicare’s interest into account

Stockwell Sievert Law Firm

If you make payments under liability insurance or self-insurance, don’t rely solely on the claimant or his attorney to take Medicare’s interest into account. If the government is not repaid the medical bills fronted by Medicare, then the feds can pursue the Medicare beneficiary, his attorney and the liability payer for repayment. That is a message reiterated in a recent federal court opinion from Arizona, Haro v Sebelius (D. Arizona May 5, 2011), No. 4:09-cv-00134-DCB:


                 “If the beneficiary or other party receives a third party payment and does not

reimburse Medicare, the third party payer must reimburse Medicare even though it has already reimbursed the beneficiary. See 42 C.F.R. § 411.24(h) and (i)(1). Congress expressly allocated this burden to the third-party liability payer that makes its payment to a party other than Medicare when it is, or should be, aware that Medicare has made a conditional payment. Id. at § 411.24(i)(2).” Id. (Emphasis part of the opinion.)

Double damages are recoverable from liability payers who do not take into account Medicare’s interest.
42 U.S.C. § 1395y(b)(3)(A).

“(The Haro opinion) underscores the defendant’s interest, and indeed obligation, to make sure that Medicare gets properly and timely reimbursed,” writes Victoria Vance, an Ohio attorney who specializes in Medicare law. “When negotiating settlements with plaintiffs, defendants can use this opinion to insist on a protocol that provides prompt and direct repayment to Medicare of amounts that are not in dispute.”

by: Paul "Sonny" Marks



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