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

www.lienresolutionusa.com

https://lienblog.wordpress.com

rweiner@lienresolutionusa.com

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.

LRS Public Comment: CMS-6047-ANPRM – CMS Proposed Rules for Liability Medicare Set-Asides

As you should know, Medicare has taken its first steps toward requiring Medicare Set-Asides in all personal injury cases.  On June 15, 2012, it (via CMS and HHS) posted a request for public comment on rules it hastily created for a potential LMSA system.  Our initial analysis of the federal register posting from June 15 can be found on our blog: Advanced Notice of Proposed Rulemaking.

We have finished our initial Public Comment on the matter.  You can read our Public Comment by clicking this link.

If you agree with our comment we urge you to e-sign in agreement by clicking here.

Our Public Comment emphasizes the long-term impacts that LMSAs will have on all personal injury cases.  We believe the requirement of LMSAs will create an unsustainability that severely limits this legal field.  Please take your time to read our comment and  e-sign in agreement by clicking here.

 

Ryan J. Weiner

Lien Resolution Services

www.lienresolutionusa.com

https://lienblog.wordpress.com

rweiner@lienresolutionusa.com

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.

Medicare Secondary Payer Recovery Portal is Live

The Medicare Secondary Payer Recovery Portal (“MSPRP”) is live and online through MSPRC.info.  If you ever tried the automated phone system you know that was a massive failure that could not provide the information you needed.  It didn’t really allow you to log complaints, request certain items, check on overdue statuses, etc.

So does the MSPRP work?

Maybe.  We’re waiting on our account access right now.  CMS and the MSPRC are being very careful, only providing corporate IDs to organizations who should receive access.  We do have a sort of “backdoor” access through a client who graciously allowed us to use her individual access.  Later in the week we will show you screenshots (with redactions) from her case.

From the MSPRC:

The Medicare Secondary Payer Recovery Portal is Live!

A new online Self-Service Tool to help manage your Medicare recovery case.

The Centers for Medicare & Medicaid Services (CMS) has implemented a new web-based tool designed to assist in the resolution of Liability Insurance, No-Fault Insurance, and Workers’ Compensation Medicare recovery cases. The new tool is called, The Medicare Secondary Payer Recovery Portal (MSPRP).

The MSPRP gives users (attorneys, insurers, beneficiaries, and TPAs) the ability to access and update certain case specific information online. Activities that currently require written communication or telephone calls to the Medicare Secondary Payer Recovery Contractor will soon be able to be done through the portal.

The MSPRP will allow users the ability to electronically perform the following activities:

• Submit Proof of Representation or Consent to Release documentation – Instead of mailing in an authorization, users will be able to upload authorizations through the portal.
• Request conditional payment information – Requesting an updated conditional payment amount or a copy of a current conditional payment letter will be as simple as clicking a few buttons.
• Dispute claims included in a conditional payment letter – Users will be able to view the claims listed on the conditional payment letter and dispute unrelated claims online.
• Submit case settlement information – Users will be able to input settlement information online and upload a copy of the settlement documentation through the portal.

Click here to learn how to register and access the portal. All information on the new portal is located in the Tool Kits section above.

At Lien Resolution Services we can assist you with Medicare lien resolution, Medicaid lien resolution, ERISA liens, private insurance liens, and more.  We’ll take care of getting you the “lien” and reducing it too.

 

Ryan J. Weiner

Lien Resolution Services

www.lienresolutionusa.com

https://lienblog.wordpress.com

rweiner@lienresolutionusa.com

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.

CGI v. Rose – 9th Circuit Reduces ERISA Lien Rights

Last Thursday, Public Justice won a federal appeals court ruling limiting ERISA plan’s ability to collect from personal injury lawsuits.  This is Public Justice’s second ERISA lien victory in less than a year.  Their tireless work has provided plaintiffs with a ray of light for us to fight the ERISA liens that so greatly limit personal injury recoveries.  In its “E-lert” from Thursday, Public Justice Executive Director Arthur Bryant wrote,

For the second time in the last year, Public Justice has won a federal appeals court ruling that an employer-based insurance plan is not entitled to full reimbursement of medical claims from an injured beneficiary who recovered only a fraction of damages from the person who caused the injury.  Last November, in the first Public Justice victory, the Third Circuit similarly blocked a plan’s attempt to obtain 100 percent reimbursement.

In its heavily anticipated ruling in CGI v. Rose yesterday [Wednesday, June 20, 2012], the Ninth Circuit agreed with the Third Circuit, holding that “parties may not by contract deprive [a court] of its power to act as a court in equity,” and made clear that notwithstanding the express terms of a Plan, it is within a district court’s broad equitable powers under ERISA to apply principles of equity in fashioning appropriate relief.

In a concurring opinion, Circuit Judge Schroeder observed that it would be “manifestly unfair” to allow the plan to recoup 100 percent of its medical expenses.  Such a result, Judge Schroeder wrote, would “leav[e] the beneficiary vastly undercompensated for her actual damages” and “unjustly enrich” the ERISA plan, which had been paid premiums for the expenses it was now seeking to recoup.

The court also flatly rejected the insurer’s attempt to sue the attorney who represented an injured woman in her case against a third party.  That holding is the first in the country to deny insurers the ability to intimidate by threat of lawsuit the lawyers who represent injury victims.

Mr. Bryant also noted that more than 170 million Americans are covered by an ERISA health insurance plan.  That means nearly 55 percent of Americans could benefit from this decision.  Equally important is to review the cross-section of America that follows this new equity rule.  Because of Public Justice’s success in the 3rd Circuit and 9th Circuit, more than 85 million Americans live in jurisdictions that follow this rule.  Back to percentages – that is 27.4% of Americans.  Keep in mind only one circuit has ruled unfavorable on the same question – the 11th Circuit (FL, AL, GA).  The other circuits have not yet been provided the opportunity to rule on this issue.

 

What does CGI v. Rose mean for ERISA liens?

This case seems to create a silent maximum lien for ERISA liens in personal injury.  Your best reduction tools are our usual favorites: the common fund doctrine reduction for attorney fees/costs and the made whole doctrine.  We suggest you don’t get greedy as ERISA lien holder’s greed is what forced these cases in the first place.  The most likely scenarios are 50/50 splits of net settlements where the ERISA lien exceeds the client take-home.  Many state Medicaids follow such a rule.

We also have some concern that the Supreme Court will review either this case or McCutchen v. US Airways.  After all, the court composition hasn’t really changed since Sereboff came down in 2006 (it remains 5-4 conservative).

Please click here for a copy of CGI v. Rose.

 

Ryan J. Weiner

Managing Partner

Lien Resolution Services

www.lienresolutionusa.com

https://lienblog.wordpress.com

rweiner@lienresolutionusa.com

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.

9th Circuit ERISA: CGI v. Rose

We have been told CGI v. Rose, the 9th Circuit version of U.S. Airways v. McCutchen, was decided on with a pro-plaintiff result. We are trying to obtain a copy of the decision now – and we will analyze it as soon as we have it.

Federal Register – June 15, 2012: Advanced Notice of Proposed Rulemaking (LMSAs)

The Friday, June 15, 2012 Federal Register includes a four-page request for public comment requested by the Department of Health and Human Services’ Centers for Medicare & Medicaid Services.  The comment is requested for potential changes to 42 CFR Parts 405 and 411 and is titled, “Medicare Program; Medicare Secondary Payer and ‘Future Medicals.’ “

The summary for the advanced notice of proposed rulemaking reads:

This advance notice of proposed rulemaking solicits comment on standardized options that we are considering making available to beneficiaries and their representatives to clarify how they can meet their obligations to protect Medicare’s interest with respect to Medicare Secondary Payer (MSP) claims involving automobile and liability insurance (including self-insurance), no-fault insurance, and workers’ compensation when future medical care is claimed or the settlement, judgment, award, or other payment releases (or has the effect of releasing) claims for future medical care.

DATES: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on August 14, 2012.”

Why is Medicare Requesting Comment?

This request for comment is essentially made by Medicare and its agents.  Ignore the use of the names HHS and CMS.  Simply consider these organizations as “Medicare.”

The stated purpose is to solicit comment on:

[s]tandardized options that beneficiaries and their attorneys or other representatives will be able to use to resolve MSP obligations related to settlements, judgments, awards, or other payments (hereinafter … “settlement(s)”)  involving future medical care while protecting Medicare’s interest.

More simply, the Advanced Notice is to begin setting up a process for Liability Medicare Set-Asides (“LMSA” or “LMSAs”).  This in turn means Medicare is attempting to recoup more funds to which it believes it is statutorily entitled via subrogation.  We all knew this was coming and we have all feared its arrival.  But this notice is a good thing. It gives us all the opportunity to educate Medicare on how best to set up an LMSA process – if one is possible at all.  We believe an LMSA process is possible, but the LMSA process must be severely limited due to its marked differences with Workers’ Compensation (which already has an MSA system).

To What is Medicare Requesting Comment?

Medicare is requesting comment on:

1. The definition of:
   1. Chronic illness/condition;
   2. Physical trauma;
   3. Major Trauma;
   4. Future Medical Care; and,
   5. Date of Care Completion;
2. The use of the Injury Severity Score (ISS) in predictive modeling of injuries and the need for future care;
3. Seven (7) options for addressing “future medicals” for both Medicare beneficiaries and non-beneficiaries in liability settlements.  Those options are:
   1. The beneficiary pays for all case-related future medical care until his/her settlement is exhausted AND documents it accordingly.  This is known in the industry as the “Poor Man’s MSA;”
   2. A small claim safe harbor (with conditions);
   3. A Doctor’s note that the beneficiary has completed treatment;
   4. A full Liability Medicare Set-Aside (LMSA);
   5. The beneficiary participates in one of Medicare’s conditional payment recovery options (these are all small claim only);
   6. Upfront payment to Medicare; and,
   7. The beneficiary receives a compromise or waiver (where the Medicare lien is greater than 50% of the client’s net settlement).

 

LRS’s Initial Reactions

This Advanced Notice does NOT mean LMSAs will be mandatory.  But if we do not react appropriately, they could become mandatory in the future.  We are in the process of preparing a formal public comment – this is not that comment.

An unlimited LMSA system with the requirement that Regional CMS offices review and agreeto the LMSA could cripple the personal injury world.  Why?

1. Preparations of MSAs are expensive, ranging from $2,500-$4,000 for submission;
2. MSAs are backlogged for Workers’ Compensation, requiring a 9 month wait on top of the normal case litigation process;
3. The current WCMSA system is based on litigation that separates the different areas of recovery in Workers’ Compensation (medical bills, lost wages, future medicals).  The liability system of settlement rarely separate those areas of recovery and adds non-economic damages (pain and suffering, loss of companionship/consortium, etc.) to the mix.  Medicare’s agencies have fought the idea of allocating settlements without judicial intervention on the merits.  This means you cannot write an order that 15% of the settlement is for future medicals and ask a judge to sign that order.  Medicare will not recognize it.  Instead, Medicare claims the judge must hear testimony for Medicare’s agents to agree with allocations.  Such a system would be unworkable and create massive backlogs in the judicial system.  Further, Medicare might still argue a state court judge has no jurisdiction over it; and,

LMSAs could even cripple the Medicare Trust Fund.  Medicare’s potential requirement of LMSAs would mean a short-term gain for the Medicare Trust Fund.  In the long-term the huge number of smaller liability cases would plummet, leaving Medicare with fewer and fewer recoveries and effectively forcing Medicare to become the primary payer.

Our full analysis of this subject will be available within the next few weeks. We will offer the opportunity to sign our official public comment as a supporter prior to our submission on August 13 (one day prior to the deadline.).

If you would like to include your own comment to be submitted with the LRS comment, or, are interested in signing our comment please contact me at rweiner@lienresolutionusa.com.

Regards,

Ryan J. Weiner

Managing Partner

Lien Resolution Services

www.lienresolutionusa.com

https://lienblog.wordpress.com

rweiner@lienresolutionusa.com

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.

Federal Register: Advanced Notice of Proposed Rulemaking for Liability Medicare Set-Asides (LMSAs)

The Friday, June 15, 2012 Federal Register included an Advanced Notice of Proposed Rulemaking for Liability Medicare Set-Asides (LMSAs).  That notice can be found by clicking the link: Federal Register: Advanced Notice of Proposed Rule – LMSAs.

At Lien Resolution Services we recognize the overwhelming majority of our clients disagree that LMSAs can apply to liability personal injury lawsuits.  Too many factors differentiate liability cases from workers’ compensation cases.  We are currently preparing our public comment.  We promise no less than an outline of that comment will be available on this blog website within the next 24 hours.

Please check back for more information.

Ryan J. Weiner

Lien Resolution Services

www.lienresolutionusa.com

https://lienblog.wordpress.com

rweiner@lienresolutionusa.com

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.

Misconceptions: It’s Not a Valid “Lien” Unless They Put Me on Notice

The most troubling “liens” are the ones that come up unexpected.  But why do liens come up without warning?

For starters, we have to remind you that we all use the term lien loosely.  Most of the time we are not dealing with liens at all.  The usual encumbrance is either a subrogation right, a reimbursement right, or if the plan drafters were smart, both of those.  We use the term lien to cover those rights as well as true liens.  The key to any lien resolution is always the plan language (don’t believe us? Check out how we were able to defeat an ERISA lien recently).

Liens are valid when…

Plain old actual liens are usually governed by a state lien act.  If your state doesn’t have a lien act you must look to equitable doctrines to see if the case law allows a lien.  Because they vary so great by state it is difficult to write a concise blog post on real liens.  The most likely reason a lien is valid is if you have notice of it prior to settlement.

Subrogation is valid when…

For the most part, subrogation is valid when a health plan language says it is valid.  If the master plan and the summary plan disagree on subrogation further legal analysis will be needed.  But your ignorance of subrogation does not mean the plan cannot come after settlement funds.  In fact, most good subrogation provisions state that it is the beneficiary’s responsibility to report a lawsuit is underway.

Reimbursement is valid when…

Reimbursement rights work the same was as subrogation rights.  Look to the plan language.  Some states may also have common law rules for reimbursement.  Just like subrogation, a well written health plan document will state that it is the beneficiary’s responsibility to inform the plan of a lawsuit.

Medicare Liens are valid when…

Always.  Medicare liens are valid always.  Medicare liens are not liens of course, but that’s what we all call them.  You have a duty to report existence of a case to Medicare.  The only limitation might be the statute of limitations (28 U.S.C. 2415) where Medicare has six (6) years and three (3) months from the settlement date to recover Medicare’s claim.

At Lien Resolution Services we can assist you with Medicare lien resolution, Medicaid lien resolution, ERISA liens, private insurance liens, and more.  We’ll take care of getting you the “lien” and reducing it too.

 

Ryan J. Weiner

Lien Resolution Services

www.lienresolutionusa.com

https://lienblog.wordpress.com

rweiner@lienresolutionusa.com

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.

 

ERISA, ERISA, ERISA!

In lien resolution (or subrogation, or reimbursement) ERISA means nothing.  Let’s get that out of the way.  Health plans can scream “ERISA!” at the top of their lungs.  It still means nothing.

One of 0ur younger attorneys at Lien Resolution Services dealt with this very issue last week.  I like the way this ERISA lien case was handled, so I will share a timeline of events:

• April 1, 2012: LRS sends settlement information and claims dispute to a Subrogation Company (we’ll call them “Subro”). LRS states the case-related payments are $1800 and requests a reduction for attorneys’ fees and costs.  LRS asks for plan language/summary plan document.
• April 22, 2012: Subro agrees to LRS claims dispute.  Offers $1200 to settle the Subro interest and provides plan language.
• May 3, 2012: Following review, LRS requests proof the plan provides for reimbursement, or, in the alternative, that Subro accept $400 to close its file.
• June 1, 2012: Subro offers to accept $1000 to settle the Subro interest.  Subro sends a 2nd copy of the plan language but does not provide proof  of or point to reimbursement provisions.
• June 10, 2012: LRS again asks for proof of the plan’s reimbursement provisions.  LRS notes the following:
  • The plan is silent as to both subrogation and reimbursement;
  • Statements that the beneficiaries have certain rights under ERISA are seen in the plan language;
  • ERISA does not create any subrogation-type interests.  It is silent as to subrogation.  “The only provision of the ERISA statute that comes close to dealing with subrogation or reimbursement is 29 USC 18 §1102(b)(4), which states, ‘Every employee benefit Plan shall specify the basis on which payments are made to and from the plan.’ ”  Emphasis Added;
• Without any subrogation or reimbursement language, look to State law for such rights:
  • This case would have been venued in Michigan.  Michigan law’s most applicable statute seems to be MCL 550.1401(5), which allows health plans to contract for subrogation rights in policy terms.  It does not create those rights where the plan is silent;
  • We thought the most applicable Michigan common law (case law) was Steinnman v. Dillon, where the plan language included a subrogation right for the subrogation company, but did not include a right to reimbursement.  670 N.W. 2d 249 (Mich. App. 2003).  The court refused to write in a reimbursement right where it was not provided for in the plan language.
• We concluded with a statement that the Subro offer amount was being held in trust until a time where it proved its reimbursement rights, and we stated, “Please provide proof that such reimbursement interests legally exist within the [Insurance Co.] plan language.” (we wrote that in bold).
• June 11, 2012: Subro reply letter reiterates offer of $1,000 and includes the Form 5500 filings to help prove ERISA status.  No direct reply to LRS questions.

On June 12, 2012, we wrote back to “Subro.”  We neatly organized a timeline in a fashion similar to the timeline above.  We closed the letter with:

As we have noted on numerous occasions, ERISA status does not create a reimbursement right.  Only plan language can do so.  As a result of the foregoing, it is our decision to withdraw all offers of payment to close your file.  We have requested proof that reimbursement is legal and proper in this case.  You have not provided anything beyond proof that the plan is an ERISA plan.

We are closing our file and distributing to [beneficiary’s] estate.  All other offers are withdrawn.  Thank you for your prompt responses to our previous letters.

We are awaiting an apply from “Subro.”  Obviously they will disagree.  Nonetheless, the file is closed, funds will be distributed by court order soon.

How do you think our young attorney did? I think that went pretty well.  The key to this situation is not that it is an ERISA lien situation.  In fact, these arguments would have worked for a private health lien that is not ERISA.  The key is the plan language.  This plan was completely silent as to reimbursement or subrogation.

So it’s not ERISA, ERISA, ERISA.  It’s Plan, Plan, Plan!

 

In addition to ERISA subrogation, we can assist you with Medicare lien resolution, Medicaid lien resolution, private insurance companies’ liens, and more.

 

Ryan J. Weiner

Lien Resolution Services

www.lienresolutionusa.com

https://lienblog.wordpress.com

rweiner@lienresolutionusa.com

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.

 

Medicare Advantage Plan Liens & Reimbursement

Medicare Advantage Plans often claim liens and/or reimbursement rights on personal injury lawsuits.  This post isn’t about Medicare Advantage (“MA”) plan reimbursement rights (or whether the Medicare Secondary Payer statute allows federal actions for MA plans).  Instead, this post aims to assist in reduction of MA plan liens.

Last week, we were offered a 25% reduction to settle a $1,452.29 Medicare Advantage lien.  The subrogation firm would accept $1,089.21 on a $75,000.00.  Many attorneys will simply accept that $152 extra they are being asked to pay – but we were given the go-ahead to reject that offer.  Below is our statute-heavy response to the MA Plan’s subrogation firm (with necessary redactions):

Thank you for your offer to accept $1,089.21 to satisfy your reimbursement interest.  We appreciate the offer to reduce by twenty-five percent.  Unfortunately, we disagree that it is the correct amount.

Your January 18, 2012 letter to ________________ at my office cites to 42 U.S.C. 1395 and its corresponding federal regulations.  Your letter specifically cites to 42 U.S.C. 1395w-22(a)(4) which in turn cites 1395y (b)(2) – “Medicare Secondary Payer,” or the statute cited by the federal government in its recovery of regular Medicare payments for third party lawsuits like Ms. _________’s suit.

If you claim reimbursement under those acts, you must act in accordance with those acts and their corresponding federal regulations.

As a result, you must comply with 42 C.F.R. 417.528 (a regulation you cited) which references 42 C.F.R. 411 et. seq. (Part (a) ‘Limits on payments and charges. (1) CMS may not pay for services to the extent that Medicare is not the primary payer under section 1862(b) of the Act and part 411 of this chapter.’).  Your twenty-five percent reduction does not comply with 42 C.F.R. 411.37, which states:

(a)   Recovery against the party that received payment— (1) General rule.

Medicare reduces its recovery to take account of the cost of procuring the judgment or settlement, as provided in this section, if—

(i)                 Procurement costs are incurred because the claim is disputed; and,

(ii)               Those costs are borne by the party against which CMS seeks to recover.

 We have provided you with a statement of procurement costs.  Part (c) of that regulation (411.37) lays out the Medicare procurement formula.  Applying those costs to the formula your reimbursement interest becomes $937.38.  Please provide us with a new confirmation of final reimbursement so that we may provide you with payment.

This might be the first work product we’ve ever posted to the lienblog.  The key to this letter is that it isn’t rocket science – but it was fun throwing the “you cited” arguments at them!

We will separately address the current status of MA Plan recovery rights in federal court in a future blog post.   The above is meant to be used where you plan to resolve a so-called lien – if you want to fight its validity in whole you will likely end up in court.  Please contact us for any lien resolution support or assistance.  In addition to Medicare lien resolution, we can assist you with Medicaid lien resolution, ERISA subrogation, private insurance companies’ liens, and more.

Ryan J. Weiner

Lien Resolution Services

www.lienresolutionusa.com

https://lienblog.wordpress.com

rweiner@lienresolutionusa.com

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.