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A Medicare Lesson

     This blog topic is not a grabber. There, I violated the first rule of writing by inserting a first sentence that seems to say, “move on, nothing interesting here”.  In fact, here is the theme of no surprise: Government run Medicare needs a new  law to make it work more effectively.

     I deal with medicare in my law practice. I use the term “deal” with medicare, when in reality, it is very hard to get in touch with a Medicare representative.  I am usually trying to reimburse Medicare from client settlement proceeds, as a result of health care providers that have been paid by medicare. Really! I am trying to pay Medicare money.

     The law says that Medicare is entitled to reimbursement, when  bills relating to a car crash have previously been paid,  and my clients later receive proceeds of settlement as a result of that crash. Specifically, once Medicare makes a payment, they have a lien against the accident settlement proceeds.

      Despite the seemingly expected ease of payback, many of my client’s settlements are slowed down because I cannot get in touch with a Medicare representative or I cannot get a final lien amount. Despite that, the lien continues and can even potentially make me, as the lawyer, legally and/or ethically  responsible,  if I ignore an unknown lien amount. In addition, Medicare delay can last for months or even a year.

   This Medicare law governing reimbursements  doesn’t seem to be law that makes sense. Of course, I am told that there is a California law that says that “No vehicle without a driver may exceed 60 miles per hour”.  In Maryland, it is against the law to take a lion to the movies or throw a bale of hay from a second story window. I’m not making this up. Still, Medicare is a  “stranger than” to me. Why is it so hard to pay back money to the government?

     I’m not the only one that thinks there is a problem. Currently,  a bill is now pending in Congress (H.R. 4796) called the Medicare Secondary Payer Enhancement Act. No,  it’s not  lip plumper legislation.

     Representatives Patrick Murphy (D-PA) and Tim Murphy (R-PA) have introduced this bill to streamline repayments.  1) Medicare would have to respond to a recovery demand letter (a request asking for a final lien amount) or risk losing entitlement to the lien;  2)Medicare would be required to develop and implement an appeals process, when there is an issue with the lien that is claimed by medicare;  3)There would be a 3 year statute of limitations for any Medicare Secondary Payer claims.

     Currently, Medicare can move at its own pace in responding. Getting a live person on the phone is quite a surprise. Many times, after chasing them for the lien, there is correspondence of a lien that does not represent an accurate amount,  that coincides with the payments from treatment and the crash. Medicare notifies at their timing, tells you the amount that they say is due and sometimes it is basically a letter that says “you pay this or we’ll keep tacking on interest”, and they do. Even when you write to question a bill that was paid, relating to treatment that was provided before the date of the crash.

     This is not a blog on the issue of Government mandated insurance. However, if Medicare reimbursement is any prophecy of the future, then we might all be in for some hard times, to get  authorized treatment. It makes me sometimes  feel like I’m dealing with Junior, from the old “Hee Haw” Show.  He would just tell us to call “BR 549”.  

     This bill is currently endorsed by such organizations as Safeway, the American Insurance Association, the Defense Research Institute and Walmart. Hopefully, delay and uncertainty can be fixed by this and the government can even get their money quicker. How is that a bad idea?

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