MANDATORY REPOTING OF SETTLEMENTS NEW MEDICARE RULES

Liability settlements of Medicare beneficiaries that occur after October 1, 2010 will be reported to Medicare's Coordination of Benefits Contractor. Liability carriers must begin mandatory reporting by January 2, 2011 and reports must be made, regardless of whether there has been a determination of liability. Failure to report will result in very stiff penalties.

The purpose of the reporting is to ensure that persons responsible for injury to a Medicare recipient pay for the medical care Medicare would otherwise cover and remove the burden of payment from the taxpayers. It is presumed that the reporting will result in increased enforcement of Medicare rights, including recovery of Medicare liens. Reporting goes beyond reporting of settlements. Carriers will also be reporting the existence of claims by Medicare or Medicare eligible beneficiaries. (See 42 U.S.C. Section 1395 y(b) and sub sections.)

The beneficiary, or those who receive payment of settlement proceeds, must reimburse Medicare any amount received (after offset for fees and costs) from a third party after receiving a Medicare payment for the same item or service. Failure to comply with the regulations can result in suit and harsh penalties. (See C.F.R. Sections 411.24 to 411.37.)

The contact for the contractor in charge of Medicare lien recovery is www.msprc.info where you should click o "tool kits." You may also call the MSPRC at 866-677-7220 but have a copy of the beneficiaries Medicare card available for the call.

Sound easy? Actually, it gets difficult when there are issues of comparative negligence, low liability limits, post-settlement expenditures (future medical specials), Medicare expenditures and reimbursement requests that are not part of plaintiff's damages. The scenarios are endless.

Notify the MSPRC early and give detailed information about the liability and insurance issues that will impact the claim. Obtain detailed information from Medicare regarding its lien, by line item. The parties need all of this information before attempting to negotiate settlement. Provide all of the Medicare lien information to your mediator, if you have one, as the lien may be an impediment to settlement.

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