Dealing with Medicare or Medicaid in Your Personal Injury Case

If you're a recipient of Medicare or Medicaid and you were injured due to the negligence of someone else, you should use that coverage to treat your injuries. Medicare and Medicaid (CMS), however, have a legal right to reimbursement for some of their costs from the proceeds of your settlement or judgment for treatment related to the accident that caused the injuries. You or your attorney have an obligation to notify them of any accident where they provided treatment.

Your attorney should notify CMS as soon as possible regarding the accident. Once your treatment is complete, CMS will issue a conditional payment letter requesting reimbursement for portions of payments they made on your behalf. These payments can be appealed as unrelated to the accident because CMS will often include any treatment subsequent to an accident as related. Negotiations can also be made to reduce their reimbursement amount if there are other medical providers that have a lien on the case.

It is important to know where you stand with CMS when you decide to either settle or proceed with litigation because their portion will come out of an settlement or judgment you receive. When a settlement is made, you or your attorney also have an obligation to notify CMS of that total settlement amount and the amount of attorney's fees. If payment is not made, monies owed to CMS will start to accrue interest after a settlement has been made. Many times the insurance company will not disperse settlement proceeds until after CMS issues are resolved because they can also be pursued by CMS for their conditional payment reimbursement.

If you were injured in an accident, it is important to have an attorney to navigate these issues on your behalf.


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