Known as the secondary-payer process, Medicare often stands in the way of malpractice settlements. While Medicare is normally a primary payer for the elderly and disabled, it becomes the secondary payer for medical bills after cases like accident injuries. This means that after Medicare pays the bills, they are later entitled to recoup at least some of the payments.
This money comes from the responsible party either through settlements or through awarded damages. The problem here is that the settlement, which is often agreed to in order to avoid a lengthy trial, must include future Medicare costs. That estimate can only come from the Center for Medicare and Medicaid Services (CMS), which creates a bureaucratic nightmare for all parties involved.
Talks often hit an impasse at this point. Sometimes, CMS burdens the talks not with delay, but with frivolity, such as when they asked for less than $2 in future Medicare costs. According to the Congressional Budget Office, Medicare loses at least $1.1 billion over these kinds of inefficiencies.
Although CMS claims to be working on it, the SMART Act (Strengthening Medicare and Repaying Taxpayers Act) has been introduced in both chambers of Congress to streamline the process and force CMS to expedite their reported estimates. The bill has gained bipartisan support, but has taken some time due to the complexity of the matter.
In 2007, Congress legislated mandatory reporting of settlements to CMS, so the agency wouldn't have to actively pursue cases from which to recoup payments. The burden has been felt throughout the medical malpractice community ever since implementation.
As a practicing medical malpractice, wrongful death, and personal injury attorney in New York, I deal with legal inconveniences like this every day. If you have experienced related problems, I want you to pick up the phone and call me. I can help.
If you would like more information about how medical malpractice and accident cases work in the state of New York, I encourage you to explore my educational website. If you have legal questions, I encourage you to pick up the phone and call me at 516-487-8207 or by e-mail at [email protected] to answer your questions. That's what I do every day. I welcome your call.