June 2010

One of the biggest headaches today in representing senior citizens in personal injury cases is the Medicare Secondary Payer Act.  Whenever Medicare has paid for treatment, or may in the future pay for any treatment even tangentially related, it may demand repayment out of a personal injury settlement. So far, so good, at least in abstract theory.
 
In practice, however, the system is absolutely riddled with inefficiency. While Medicare’s contract with its sole source recovery contractor, Chickasaw Nations Industries, calls for providing a "conditional payment letter" within 30 days after request, that does not happen. We have had cases where it took 6 to 12 months to get the "conditional payment" number from them, and even then it is not a reliable number.
 
Legislation now pending in Congress, HR 4796, the Medicare Secondary Payer Enhancement Act of 2010 would correct this problem by requiring the Center for Medicare Services (CMS) to respond to requests for their lien amount within 60 days. Self-funded by a $30 application fee, this bill costs the taxpayers nothing, and it has the broad support of coalitions in insurance, large businesses and plaintiffs’ trial lawyers, all of whom have been frustrated by the inefficiency of the current system. The bill may not be perfect, but it is a vast improvement over the current mess.
 
The Medicare Secondary Payer system at present makes it extremely difficult to reasonably settle cases and impairs access to justice by making it uneconomical for lawyers to represent seniors on Medicare in injury cases. HR 4796 should be passed.