GENERAL

1. Do I have a recourse if I feel the recovery amount should be waived?
2. Can an attorney apply for a waiver of the debt due to Medicare on behalf of a beneficiary?
3. How long will it take before I receive an answer to my request for a waiver?
4. Is there an appeal procedure if the waiver request is denied?

1. Do I have a recourse if I feel the recovery amount should be waived?

   Yes, if the beneficiary meets the criteria for financial hardship or equity and good conscience. The attorney may request a compromise or waiver of the Medicare claim on behalf of his client by completing the appropriate forms and returning them to the lead contractor. These forms will be provided upon written request after settlement documentation has been received.
   

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2. Can an attorney apply for a waiver of the debt due to Medicare on behalf of a beneficiary?

   There is a waiver process for instances where collection of the debt will effect a financial hardship or is otherwise unfair. A waiver request is premature until the claim or lawsuit is settled and a final payment demand letter has been sent from the Medicare contractor. A waiver request is acknowledged and the attorney is sent forms for the beneficiary to complete. The forms need to be returned in 30 days, although replying sooner can generate an earlier decision. The Medicare contractor is required to make a waiver determination within 120 days of the date of the request. The decision may be to deny, grant or partially grant the request. Interest mandated by HCFA continues to accrue while the waiver request is pending. As a result, the best course is to pay the debt within the 30 day deadline of the payment demand letter and seek reimbursement through the waiver process.
   

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3. How long will it take before I receive an answer to my request for a waiver?

   Waivers may take up to 120 days from the date of the attorney's request. However, be aware that a request for waiver is not appropriate until the settlement has been reached and Part A notified of the settlement information.
   

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4. Is there an appeal procedure if the waiver request is denied?

   There is also a process whereby waiver decisions can be reconsidered. The request must be made within 60 days of the waiver decision. A reconsideration request is more likely to be successful if supported by new information or documentation.
   

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