Medicare: The Long Arm of the Government takes back what it paid to your doctors

Published by Charles DeStefano

Just when you thought that your hard earned would pay for your medical treatment, the long arm of Medicare takes it away at the conclusion of your lawsuit.  Under Federal Law, if you are Medicare eligible (by way of your age or disability) and have had an accident in which Medicare has paid for your medical treatment, the government has the unequivocal right to a lien against any money you receive from a lawsuit.

Your attorney must notify the government that you have been injured and that you have a lawsuit.  After your attorney has received an offer of settlement, he must then prepare a Release.  It is only until that time that the lawyer may ask the government what the amount of their lien is.

At that point, MSPRC (the agency that collects money for Medicare) will add up the total amount of medical bills and request payment from you by way of your attorney.

Your attorney needs to take certain steps to try to reduce the lien amount.  First, he needs to write to MSPSRC and request a reduction of the lien.  Usually the lawyer is able to reduce the amount of the lien if he can show that (for example) the billing codes listed in the lien do not relate to a traumatic injury.  This is a common issue with Medicare and the easiest defense to the lien.

If Medicare still refuses to reduce the lien, the attorney may appeal (by way of letter) to the Appeal Section of Medicare. This appeal is  the first level of appeal.

If the appeal still does not effectively reduce the lien, then your attorney may request  a hearing with a Administrative Judge who will decide your case.  Your lawyer will then have a trial (usually by telephone) and the Administrative will make a final decision.

If the decision is still against you and your lawyer believes that you have been aggrieved, then you may sue Medicare in the Federal Court and have a District Judge, magistrate, or jury decide your case.

Essentially, the Medicare lien is a tough battle, but a good personal injury attorney must use all of his skills to (at a minimum) reduce the overall Medicare lien.