Plaintiff and Defense Cooperation in Medicare Liens
Most settlement agreements miss a vital series of terms that all defendants must report to the government. Those terms are used in Medicare’s Section 111 reporting. They include what date of incident is being reported to Medicare, a clear statement of the settlement amount being reported to Medicare, and injury codes being reported.
Sure, date of injury and settlement amount are noted in the agreement, but those terms are often reported by outside vendors in the Medicare context. Failure to explicitly state them in the settlement agreement can lead to duplicate files at Medicare. Those duplicates are at best a headache, and at worst an extra bill to pay.
For example, look at all the possible Medicare files that can exist:
| Settlement/Payment Type | Medicare File Type | Who is “Debtor”? |
| PIP/Med-Pay (Voluntary Pay) | CRC – No-Fault* | Carrier |
| PIP/Med-Pay (via Settlement/Judgment) | BCRC – No-Fault | Plaintiff |
| Work Comp (Voluntary Pay) | CRC – Work Comp* | Carrier |
| Work Comp (via Settlement/Judgment) | BCRC – Work Comp | Plaintiff |
| Liability or Bodily Injury (via Settlement/Judgment) |
BCRC – Liability | Plaintiff |
| Underinsured Motorist Coverage (via Settlement/Judgment) |
BCRC – Liability | Plaintiff |
| Uninsured Motorist Coverage (via Settlement/Judgment) |
BCRC – Liability | Plaintiff |
| Additional Defendant in Liability (via Settlement/Judgment) |
BCRC – Liability | Plaintiff |
*Medicare’s CRC may open multiple files for these types of claims.
Why risk surprise files? Add a section into the settlement agreement for (1) date of injury reported to Medicare, (2) settlement amount reported to Medicare, and (3) injury codes reported to Medicare. Remember that multiple parties may be reporting if the case involves multiple defendants. Medicare should see that breakdown from both sides.
Ryan Weiner, Esq., MASSIVE’s COO, will discuss this topic in-depth at the virtual 6th Annual Medicare Secondary Payer Conditional Payment Forum on July 12 at 11:55 a.m. EST. Register today and use code SPKR15 for 15% off!