Medicare Secondary Payer Act

Jan 17, 2015 | Blog |

REMINDER: Pursuant to 42 USC Section 1395y(b)(2), commonly known as the Medicare Secondary Payer Act, Medicare may not make payment for medical benefits where payment has been made or can reasonably be expected to be made under a workers’ compensation law or plan of the United States or a state, or under an automobile or liability insurance policy or plan (including a self-insured plan), or under no fault insurance. By law, Medicare has a priority right of recovery from the primary payer as well as from parties in receipt of third-party payments, such as a beneficiary, provider, supplier, physician, attorney, state agency or private insurer [42 CFR 411.24(g)]. Accordingly, it is essential that all parties to personal injury insurance settlements ensure that Medicare’s interests are protected and therefore of the utmost importance for all attorneys, insurance company personnel and medical billing professionals to fully understand how and when the MSP applies in any given personal injury situation. Failure to meet your MSP obligations may have some very significant financial ramifications such as attorney personal liability as supported by the 3rd Circuit decision in U.S. v. Harris, or an insurer $1,000 per day per case fine for failure to perform MMSEA reporting.

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