Navigating Medicare: Plaintiff Attorney Obligations When Settling a Case

One common question we get is about Medicare and plaintiff attorneys’ obligations to Medicare when they’re settling a case. 

There are two parts to consider in Medicare’s interests. First is the Medicare conditional lien, which is Medicare’s right of recovery from the date of injury to the date of settlement. Most attorneys are familiar with this process — they go through the process with the Benefits Coordination & Recovery Center (BCRC) to get the conditional payment letter and obtain a final demand from Medicare that will be settled at the time of settlement.

The second part to consider is Medicare’s future interest. Medicare’s potential future interest will vary from case to case depending on the facts — and in a liability situation, the rules are less clear than they are in a worker’s compensation case.

What attorneys need to do is make sure that Medicare’s interests are considered and protected going forward. There are many factors that should be evaluated when protecting Medicare’s future interests. Although it is not a necessity to establish a Medicare set aside, it may be one option to consider. There are other solutions as well.

If you’re not sure with the facts of your particular case or what you need to do, we’re more than happy to get on a phone call and walk you through the considerations and help you and your client decide what the best course of action is for you to take from the point of settlement going forward to protect Medicare’s future interests. It will be fact-dependent so we’ll do our best to help clear that up so that you and your client can make the best decision.

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