Representation of Clients over the age of 65 is challenging because
the Attorney has no choice but to address Medicare liens. If the Attorney fails to do so, the Attorney,
personally, is potentially responsible for lien repayment.
A party
with a “lien,’ has a right to settlement proceeds as a matter of law. Federal law provides Medicare with a lien for
all amounts paid for medical treatment for which a third party is responsible.
Addressing
the Medicare lien is a complicated process requiring the Attorney to
communicate with the Center for Medicare Services (“CMS”) by submitting a
series of forms. The process begins with
the Attorney filing The Attorney begins
by filing a Proof of Representation.
CMS
responds by submitting a Conditional Payment Letter detailing the medical
services and the amounts paid by Medicare.
Often Medicare is able to obtain substantial discounts on the billed
costs of services. The purpose of the
Conditional Payment Letter is to allow review so that unrelated services can be
excluded. The Conditional Payment Letter
ends with a statement as to the amount of the lien required to be repaid
Medicare.
Because
medical treatment can be ongoing, the services and amounts in the Conditional
Payment Letter will change over time. If
unrelated services and expenses appear, the Attorney can request review to exclude
these expenses from the lien.
The
Attorney reports any settlement in a Final Settlement Detail Report which also
references the cost of attorneys’ fees, costs, and subrogation amounts. Medicare will respond with a Beneficiary
Conditional Payment letter reducing the lien by the amount of costs and legal
fees and stating the amount to repay Medicare.
Sometimes
Conditional Payment letter references an amount greater than the Client’s net
recovery. In these situations, the
Attorney can submit a Waiver of Demand and Medicare will consider further
reducing its repayment.
This
process can be both complicated and time-consuming. In a recent case, the process took more than
a year. Fortunately, the end result was
recovery for the Client.
