The Federal Government (Dept. of HHS - Medicare Division) has been very aggressive of late in making claims under a little known provision in Federal Law. This Law effects anyone injured in an accident or medical malpractice anywhere in the Country whether the matter is in Federal or State Court.
In short, anyone who receives compensation for an injury or disability must report to the local Medicare Division. The reason for this is that Medicare has an automatic lien on every recovery so that it can off set any residual costs it may have to cover for someone either already on Medicare or someone who will come on. Yes, you read that right, anyone who will come on Medicare in the future, pretty much everybody, must report their recovery and pay a portion of that recovery to Medicare if the injury is likely to come under costs that will be billed to Medicare once the person comes on Medicare.
How does Medicare know you received a recovery. The Law requires both the victim and the defendant (or insurer and lawyers on both sides) to report it or they become liable for it not to mention fines and penalties. The Judge must also account for it in the Final Order.
This system is surprising many unsuspecting litigants and lawyers. Once the matter is resolved the recovery sits in escrow while Medicare determines the amount they wish to take under its lien. This can take significant time and Medicare's review is primarily done by non-physician lay people. If a victim doesn't agree with Medicare's decision for the amount of the lien then there is an appeal process within Medicare before going to the U.S. District Court.
We have found that it is very helpful to have a medical expert on hand to analyze the case results and the lien. It cannot hurt the chances that a medical report from a medical expert who was not involved in the case to begin with can influence Medicare's decision to minimize what Medicare takes on the lien and to do so in a shorter period of time. The expert medical report highlights medical needs for the victim and helps the lay reviewer see things differently, it shows that the claimant is serious and it lays the foundation for a better probability of a successful appeal based on a stronger record.
For the same reasons as above we are starting to get calls for such reports not only for Medicare Set Asides but also in support of Veteran Claims to the Veteran's Adm. for in-service related disabilities. We're here to help with these matters and have medical experts in all fields located around the Country.
