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New Medicare Reporting Rules for Personal Injury Claims

Or, You Snooze, You Lose ‘Cause Medicare Don’t Play Dat

If you have clients with pending personal injury claims, you likely have already run across the new Medicare reporting rules. But in today’s article, “Many lawyers aren’t aware of new rules,” the Wisconsin Law Journal is reporting that many legal professionals still aren’t up to speed.

Part of the reason they may not be up to speed is confusion over the rules themselves, which has caused the government to postpone enforcement twice. They now go into effect on January 1, 2011. Well, sort of. One-time payments made on or after October 1, 2010, as well as ongoing-care settlements made on or after January 1, 2010, are already subject to the rules.

The Journal reports:

New Medicare Secondary Payer reporting rules require attorneys, insurers and even plaintiffs to report any personal injury settlement, judgment or other award to the Centers for Medicare and Medicaid Services (CMS) in cases where Medicare has rendered payment or could render future payments for care based on the injury alleged in the case. Failure to do so could result not only in CMS slapping a lien on the award for Medicare reimbursement, but also fines of up to $1,000 per day.

Having dealt with Medicare Set Asides for some time in workers’ compensation cases, I can already tell you, protecting Medicare’s interest is serious business.

This article is well worth reading in its entirety, and sharing with your colleagues. It includes several tips for making sure that personal injury cases with Medicare-eligible clients are handled properly, such as:

  • Educate everyone in the office about the new rules, including the staff.
  • Create a Medicare set-aside worksheet for each file to determine whether CMS may have a claim.
  • Make sure any Medicare issues have been addressed before mediation and/or settlement.

I’ll add my own tip: do not ignore those conditional payment letters from Medicare. Review them and reply in a timely manner.Source: Wisconsin Law Journal

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Contact Info:

Lynne J. DeVenny, N.C. State Bar Certified Paralegal

Owner & Virtual Paralegal, DeVenny Paralegal Services

Email: lynne.devenny[at]

Telephone: 336-582-0003

Inquiries are welcome, with free quotes available.

Meet Lynne:

Lynne DeVenny is a North Carolina State Bar Certified Paralegal with over 27 years of experience working on complex litigation cases, including medical malpractice, personal injury, workers’ compensation, and Social Security disability.

Disclosure: I am not a lawyer and cannot provide legal representation or legal advice.

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