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  • Home
  • About
    • About
    • Ben Sessions
    • Andrew Fleischman
    • Locations
      • Atlanta, GA Office Location
      • Macon, GA Law Office Location
      • Columbus, GA Office Location
      • Milledgeville, GA Office Location
    • Areas We Serve
      • Albany
      • Americus
      • Atlanta
      • Bartow County
      • Bibb County
      • Brookhaven
      • Centerville
      • Chatham County
      • Chattanooga
      • Clayton County
      • Cobb County
      • Columbia County
      • Columbus
      • Coweta County
      • DeKalb County
      • Doraville
      • Douglas County
      • Dublin
      • Fayette County
      • Gray
      • Griffin
      • Gwinnett County
      • Hall County
      • Hawkinsville
      • Henry County
      • Hinesville
      • Houston County
      • Jackson County
      • LaGrange
      • Lowndes County
      • Macon
      • McDonough
      • Milledgeville
      • Muscogee County
      • Newton County
      • Paulding County
      • Perry
      • Pooler
      • Richmond Hill
      • Roberta
      • Rockdale County
      • Savannah
      • Walker County
      • Walton County
      • Whitfield County
  • Practice Areas
    • Personal Injury
      • Car Accidents
      • Motorcycle Accidents
      • Truck Accidents
      • Slip-And-Fall & Premises Liability
      • Pedestrian Accidents
      • Bicycle Accidents
      • Elder Abuse
      • Product Defect Attorney
      • Defective Product Injuries
      • Negligent Security
      • Wrong Prescriptions
      • Wrongful Death
    • DUI Defense
      • 2nd DUI Offense
      • DUI Drug Offense
      • Child Endangerment DUI
      • License Suspension
    • Criminal Defense
      • Drug Charge Defense
      • Sex Crime Defense
      • Domestic Violence
      • Probation Violation
      • Vehicular Homicide
    • Appeals
    • Post-Conviction Relief
    • Workers’ Comp
      • Calculating Workers’ Comp Payments
      • Fall at Work
  • Testimonials
    • Case Results
  • Resources
    • Resources
    • Preparing for Our Meeting
    • Personal Injury Resources
      • Health Insurance Reimbursement
      • Personal Injury Blog
      • Attorney for Back Injuries
      • Spinal Cord Injuries
      • Nerve Damage
      • Attorneys for Broken Bones Caused by Accidents
      • Brain Injury
      • Scarring
    • Car Accident Resources
      • Injuries Caused by Distracted Drivers
      • Injuries Caused by Drunk Drivers
      • Injured by a driver following too closely?
      • Most Common Car Accident Causes
      • Do I Need a Lawyer for My Car Accident Case?
      • Car Accident Blog
      • Step-By-Step Car Accident Guide
    • DUI Defense Resources
      • DUI Defense Blog
      • Georgia DUI Process
      • The “Walk and Turn” Test in DUI Cases
      • The Eye Test
      • Your Driver’s License After a DUI Arrest
      • License Suspension in A DUI Case
      • Ignition Interlock Permit
      • Importance of Your Driving in Your DUI Case
      • Your Criminal Record & a DUI
  • Contact Us Now

Medicare Reimbursement From Personal Injury Settlement

Medicare Reimbursement From Personal Injury Settlement

Under the statute of limitations (28 U.S.C. 2415), Medicare has six (6) years and three (3) months to recover Medicare’s claim. The statute of limitations begins at the time Medicare is made aware that the overpayment exists.

Medicare’s overpayment does not come into existence until a judgment award or settlement offer is accepted. It is at the point of settlement that Medicare’s conditional payments are considered to be overpayments. Medicare’s claim come into existence by operation of law 42 U.S.C. 1395Y(B)(2)(B)(I) when payment for medical expenses that Medicare conditionally paid for has been made by a third party payer.

In your situation, the date of settlement was 2000, the clock started ticking on Medicare’s SOL when you notified Medicare of the settlement. Considering that you and your client have received a demand letter from Medicare, it must be addressed promptly to avoid collection efforts by Medicare, such as garnishment of your clients Social Security benefits and/or double damages for you.

Section 42 CFR 411.23 states that a beneficiary must cooperate in any action taken by the Centers for Medicare and Medicaid Services in recovering conditional payments. Failure to do so or not protecting the Medicare program during and after settlement negotiations may result in CMS taking action against the beneficiary to collect the mistaken payment.

In the event that reimbursement is not made to Medicare as required by 42 USC 1395y(b)(2)(B)(I), action may be brought against any entity responsible for payment (and may collect double damages from insurance companies), or any entity that has received a third-party settlement. Under 42 CFR 411.24(g), this includes attorneys whose fees are paid from settlement proceeds. Please refer to US v. Sosnowski, et. al. where judgment was entered against a beneficiary and his attorney for failing to reimburse Medicare after receiving settlement proceeds on a personal injury case.

CMS has a direct right of action to recover its payments from any entity, including a beneficiary, provider, supplier, physician, attorney, State agency, or a private insurer that has received a third party payment, 42 CFR 411.24.

Having said this, the best way to address the situation is to request a post-settlement compromise of Medicare’s interest. When submitting your request, craft a compelling story; provide them with the facts of the case and supporting documentation for your argument. All post-settlement compromise requests must be in writing and sent to the MSPRC Medicare Contractor), they will forward your request to the CMS Regional office. The MSPRC contractor does not have the authority to compromise. The authority to compromise a Medicare claim is reserved exclusively for the CMS home office or regional offices. Any agreement for a compromise settlement under the Federal Claims Collection Act (“FCCA”) may not be appealed.

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