Attorneys are not RREs and have no direct responsibility for reporting to the CMS.
Likewise, personal injury attorneys representing Medicare beneficiaries have no fiduciary relationship with Medicare. However, any attorney representing RREs or a client with a legal obligation to reimburse Medicare has a legal obligation to ensure that Medicare is reimbursed for conditional payments subject of a recovery by the beneficiary. In order to obtain the information needed and protect the interests of the RRE and beneficiary, as well as their own, there are several steps that attorneys should perform in any case involving a plaintiff alleging any bodily injury?
Plaintiff counsel:
1. When representing a Medicare beneficiary, counsel should immediately contact the COBC and provide the beneficiary’s name, sex, and date of birth, Social Security Number or Medicare Health Insurance Claim Number, date of incident, and a description of the incident.
2. After review of the information by the MSPRC, counsel should access the interim conditional payment information and communicate the same to the client
3. Upon a settlement, judgment or award of the matter, counsel should notify in writing the MSPRC, including the date of such agreement or otherwise, amount recovered any attorney’s fees or other procurement costs associated with same. A copy of the executed settlement, judgment or award should also be forwarded.
4. Upon receipt of a demand letter from the MSPRC, counsel should review with the client and submit an appeal or request a compromise if desired.
Defense counsel:
1. At the initiation of a suit, counsel should contact the RRE to determine if it has promulgated any forms to be completed related to the information to be obtained.
2. In the discovery phase of any case, the attorney should obtain all basic information pertaining to a plaintiff. Additionally, written discovery should include inquiries as to whether or not a plaintiff is a Medicare beneficiary, including the individual’s Social Security Number and Medicare health claim insurance number if there is one. This should be obtained as early in the litigation as possible and updated as applicable. The information as provided by the plaintiff should be verified or certified.
3. All information should be reaffirmed or reviewed in the deposition phase of litigation.
4. Upon payment of a settlement or judgment in a case, include language listed under Section IX, Representations and Warranties, Subsection 9 to release the defendant in a matter from all Medicare/Medicaid liens. In a case where the beneficiary fails to reimburse Medicare, if the settlement does not expressly release the defendant, CMS may seek reimbursement from the defendant or its insurer, even though it has already paid the beneficiary and even if liability is expressly denied.
Likewise, personal injury attorneys representing Medicare beneficiaries have no fiduciary relationship with Medicare. However, any attorney representing RREs or a client with a legal obligation to reimburse Medicare has a legal obligation to ensure that Medicare is reimbursed for conditional payments subject of a recovery by the beneficiary. In order to obtain the information needed and protect the interests of the RRE and beneficiary, as well as their own, there are several steps that attorneys should perform in any case involving a plaintiff alleging any bodily injury?
Plaintiff counsel:
1. When representing a Medicare beneficiary, counsel should immediately contact the COBC and provide the beneficiary’s name, sex, and date of birth, Social Security Number or Medicare Health Insurance Claim Number, date of incident, and a description of the incident.
2. After review of the information by the MSPRC, counsel should access the interim conditional payment information and communicate the same to the client
3. Upon a settlement, judgment or award of the matter, counsel should notify in writing the MSPRC, including the date of such agreement or otherwise, amount recovered any attorney’s fees or other procurement costs associated with same. A copy of the executed settlement, judgment or award should also be forwarded.
4. Upon receipt of a demand letter from the MSPRC, counsel should review with the client and submit an appeal or request a compromise if desired.
Defense counsel:
1. At the initiation of a suit, counsel should contact the RRE to determine if it has promulgated any forms to be completed related to the information to be obtained.
2. In the discovery phase of any case, the attorney should obtain all basic information pertaining to a plaintiff. Additionally, written discovery should include inquiries as to whether or not a plaintiff is a Medicare beneficiary, including the individual’s Social Security Number and Medicare health claim insurance number if there is one. This should be obtained as early in the litigation as possible and updated as applicable. The information as provided by the plaintiff should be verified or certified.
3. All information should be reaffirmed or reviewed in the deposition phase of litigation.
4. Upon payment of a settlement or judgment in a case, include language listed under Section IX, Representations and Warranties, Subsection 9 to release the defendant in a matter from all Medicare/Medicaid liens. In a case where the beneficiary fails to reimburse Medicare, if the settlement does not expressly release the defendant, CMS may seek reimbursement from the defendant or its insurer, even though it has already paid the beneficiary and even if liability is expressly denied.
