GENERAL

1. Where is the citing for Medicare's right of reimbursement?
2. Does Medicare have a right of reimbursement regarding Workers-Compensation benefits?
3. How does Medicare determine reimbursement situations?
4. What is the statute of limitations regarding Medicare's right of reimbursement?
5. If the attorney was not notified of a Medicare claim prior to settlement, can Medicare collect reimbursement?
6. If the case involves auto/liability insurance coverage from the client's personal insurance, is that coverage considered a third party payment?
7. Should Medicare abide by any state law that indicates comparative negligence be taken into consideration when reducing a claim?
8. Can Medicare seek recovery from uninsured motorist and underinsured motorist coverage?

1. Where is the citing for Medicare's right of reimbursement?

   Medicare has a statutory right of reimbursement based on 42 CFR 411.24(g) and 411.26(a).

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2. Does Medicare have a right of reimbursement regarding Workers-Compensation benefits?

   Yes, per 42 CFR ss411.40-47.

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3. How does Medicare determine reimbursement situations?

   Written notification from an attorney, the beneficiary, provider of services, insurance company and/or notice from another contractor/intermediary, or internal Medicare processes.

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4. What is the statute of limitations regarding Medicare's right of reimbursement?

   The Medicare program has six years after we have issued a payment demand letter or we have sufficient information to initiate the payment demand to recover the overpayment [28 USC 2415].

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5. If the attorney was not notified of a Medicare claim prior to settlement, can Medicare collect reimbursement?

   Yes, if payment is made by Medicare for a service relating to the accident/incident, Medicare must be reimbursed.

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6. If the case involves auto/liability insurance coverage from the client's personal insurance, is that coverage considered a third party payment?

   Yes, according to the definition of third party payer set forth in the Federal regulations, a third party payer is any insurance policy, plan, or program that is primary to Medicare.

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7. Should Medicare abide by any state law that indicates comparative negligence be taken into consideration when reducing a claim?

   No, Medicare is a Federal law set forth in the Federal Register and Federal law supersedes any State law.

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8. Can Medicare seek recovery from uninsured motorist and underinsured motorist coverage?

   Yes, according to 42 CFR ss411.50(b), these types of coverage are considered liability coverage and reimbursement can be recovered for Medicare overpayments.

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