Does Medicare Get Paid if I Win my Personal Injury Lawsuit?
When you are injured in a car accident or by a negligent healthcare provider, you will likely incur significant medical bills. From emergency room bills to repeated office visits, the cost can pile up quickly. If you are a senior on Medicare, chances are good that your out-of-pocket costs will be minimal. This does not mean, however, that Medicare is okay letting you get all the money from your lawsuit. Medicare generally has a right to assess what is known as a “super lien.” Here is what you should know about Medicare super liens.
What is a super lien?
When someone is injured and requires medical treatment, their Medicare coverage will generally pay for the necessary care. However, in the event the person is later compensated for those injuries, federal law requires the person to repay Medicare. This is found at 42 CFR section 411.24 (i). Once Medicare is notified of the pending action, it will generally submit a “conditional payment letter,” informing the plaintiff and his or her attorney of the estimated amount that Medicare is claiming. Medicare can only assess a lien for care that was directly related to the injuries. This should not be confused with a Medicaid lien, which is assessed by the State of Florida and has a different set of rules entirely.
So, if you are injured in an accident and require $30,000 for an emergency room visit, x-rays, medications, and several follow up appointments, Medicare can assess a lien in this amount, which you will have to repay upon resolving the lawsuit. Medicare cannot, however, recover for unrelated medications and routine care that have nothing to do with the injury. This type of lien is generally known as a “super lien.” This does not necessarily mean Medicare will take all of your recovery though.
Why does Medicare get reimbursed?
To some, this may seem unfair. After all, the plaintiff was injured and suffered the pain of his injuries. Nevertheless, if you think about it, the process makes sense. If A pays for B’s medical care because of something C did, then it only stands to reason if C ends up paying B for what happened, B should have to pay A back for the help he gave. In other words, B should not get to recover twice. But there are limits on how Medicare is paid, and who must pay it.
Negotiating your lien
According to the law, Medicare can take up to the entire amount it paid. But this does not always happen. You and your lawyer are entitled to negotiate with Medicare. Many times, personal injury attorneys are able to negotiate these liens to much less than owed. In rare instances, a $100,000 lien can be reduced to $20-30,000. This is not typical, but it can happen. In general, the Medicare employees who handle these liens understand that most cases will never settle if plaintiff knows the entire recovery will go to the government. After all, why not just walk away? Likewise, if a $100,000 case requires a $75,000 lien be repaid, then a plaintiff is likely not going to reduce his demands. Likewise, the defendant is not going to increase its offer just because of the lien. For these reasons, attorneys are often able to negotiate a fair percentage of the recovery so that both the plaintiff and Medicare are compensated.
What to do if you are concerned about a Medicare lien
If you are a Medicare recipient who has been injured by someone else’s negligence, contact an attorney who can review your case and negotiate with Medicare to get you the most money possible from your settlement. No lawyer can guarantee results, but you are much more likely to keep money in your pocket if you let an experienced Florida personal injury attorney handle your case. For questions about Medicare super liens or for a free case review, contact the Romero Law Firm, serving Bradenton and all of the Tampa Bay area.