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Medicare Advantage Plans Entitled to Medicare Liens

In late June, the 3rd Circuit held that Medicare Advantage Plans (“MAP” or “MAPs”) have the same rights to reimbursement as regular Medicare.  The district court in In Re Avandia Marketing, 2011 U.S. Dist. LEXIS 63544, (E.D. Penn. 2012) originally held the plans do not have the same rights to reimbursement as regular Medicare.  However, the 3rd Circuit took a different approach.

The underlying Avandia mass tort/pharmaceutical case involved a plethora of Medicare beneficiaries as Avandia had been used to treat diabetes patients.  Many of these patients were also MAP beneficiaries.  As a result, Humana (with its multiple MAP plans) filed suit to enforce its rights under the Medicare statute.  Humana’s goal was to enforce its private right for double damages pursuant to 42 U.S.C. § 1395y(b)(3)(A) and for reimbursement of payments it made for treatment of Avandia-related illnesses on behalf of its MAP beneficiaries.

The 3rd Circuit agreed with Humana.  You should now consider all MAP plans to have the same rights as a regular Medicare lien.

You should be even more vigilant when collecting your plaintiff’s insurance information.  If you fail to pay a Medicare Advantage Lien that MAP plan could sue you (as the attorney) for double damages.  Unfortunately, the MAP plan will receive your settlement information from Medicare through Section 111 Reporting.  They will know your case settled.  But, there is also good with this case.  If a MAP plan is provided the same rights as a regular Medicare lien under the MSP statute, it also must adhere to that statute’s reduction rules.  At LRS we believe a MAP plan cannot claim the full lien, but must reduce by your fees and costs without questioning those fees and costs.

If you need help reducing a Medicare Advantage Lien please contact us.  At Lien Resolution Services we can assist you with Medicare lien resolution, Medicaid lien resolution, ERISA liens, private insurance liens, and more.


Ryan J. Weiner
Lien Resolution Services
This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.

About Ryan J. Weiner

Co-Founder of Lien Resolution Services, LLC, a national healthcare lien resolution firm. Our goal is to assist in the fair administration and resolution of healthcare liens on personal injury cases. Please visit our website for more information: www.lienresolutionusa.com.

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