Post-Settlement
Recovery of funds due to Medicare
Once settlement has been made, the attorney will be required to send on their letterhead, the total amount of settlement, the total attorney fees and a detailed list of all costs involved in settling the case. Medicare will reduce the amount due to the Medicare Program by a pro rata share of the settlement amount in relation to the attorney fees and costs.
Interest
The Medicare Program requires that payment be made within 60 days of the settlement or interest will accrue on a monthly basis. Medicare assesses interest on MSP debts by exercising common law authority that is consistent with the Federal Claims Collection Act (FCCA).
Waivers
If you decide you are unable to repay the debt to Medicare you may request a full or partial waiver. The request must be made in writing to the Medicare office that has taken the lead. Waivers may be requested for the following reasons:
- Financial Hardship
- Equity & Good Conscience
If the beneficiary is deceased, a waiver can only be requested by a surviving spouse or dependent child who is entitled to either the Title II or Title XVII.
It should be noted that prompt repayment to Medicare will avoid accruing interest charges. You will retain your right to dispute, appeal, or request waiver of the debt. Interest will accrue during the waiver process, unless prompt payment is made.
* The case must be settled for a waiver request to be valid
Once the waiver request is received, you will be sent the HCFA 632BK forms to complete. These forms state financial information for the household of the Medicare beneficiary.
The waiver determinations are made in the lead contractors office. The waiver determination may take up to 120 days.
Compromises
Beneficiary, spouse, immediate family member, or attorney may request a compromise. A compromise can be pre-settlement or post-settlement.
It should be noted that prompt repayment to Medicare will avoid accruing interest charges. You will retain your right to dispute, appeal, or request waiver of the debt.
When a compromise is requested one of the following reasons listed below must be given.
- Litigative risk (either the beneficiary cannot testify or the case is not strong enough).
- Inability to pay
- Cost of collecting the claim
To request a compromise, the requesting party must specify an amount that they wish to pay and submit in writing the reason for the compromise, and how they determined the amount to be repaid. A full reduction cannot be requested. All compromise requests are referred to the Centers for Medicare & Medicaid Services Regional Office in Kansas City, Missouri for determination. This process may take up to 120 days.
Settlement distributed to the beneficiary before repaying Medicare
Once it has been determined that the settlement has been disbursed to the Medicare beneficiary, Medicare will send a demand to the beneficiary for repayment of the amount due to the Medicare program.
If neither payment nor a response is received from the beneficiary, Medicare has the authority to refer the overpayment to the Social Security Administration for further recovery action.
Recovery of funds due to Medicare when a group insurance should have paid as primary.
The Medicare program identifies through claims submitted by providers for payment any situations in which Medicare has paid as primary, but may be the secondary payer.
In these situations the Medicare program is required to send a demand for repayment to your or your spouse's employer if they were primary during the time for the claim(s) in question.
During the investigation of these claims you may receive a letter from Medicare asking for employer and insurer name and address for a particular time frame. By providing this information, you will help to expedite the correct recovery of these claims.
Settlement consists of:
- Date of settlement
- Amount of settlement
- Amount of attorney fees - not a %
- Itemized listing of costs incurred to settle the case
Fax complete settlement info to:
Accounts Receivable Team
402-351-3521
Page Last Updated: Thursday, 17-Jul-2008 10:11:30 CDT
