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Medicare and Medicaid Subrogation Is a Long Bureaucratic Process


Just as insurance companies seek reimbursement through subrogation, Medicaid and Medicare also have legal rights to subrogation. Medicare’s rights to subrogation in personal injury or wrongful death settlements are outlined by 42 United States Code 1395y(b)(2)(B)(iii).

Medicare liens

The main difference between Medicare and other liens is that Medicare liens take priority when attaching to settlements or judgment awards. The insurance carrier paying a settlement, attorneys, and personal injury client are all liable for reimbursing Medicare. If the Medicare lien exceeds the total amount of recovery, Medicare obtains all of the money, including expenses and lawyer’s fees. Your attorney can seek a waiver or reduction of a lien if it would lead to substantial financial hardship. Your attorney can also appeal the lien amount on your behalf.

With a lien, your attorney has to verify that all expenses covered by the Medicare are valid, meaning that they occurred between the injury date and award or settlement date. Attorneys must also ensure that the expenses that the lien addresses are for the same injury covered by the personal injury lawsuit.

The bureaucratic process involved with resolving a Medicare lien can take anywhere from six months to a year.

Medicaid liens

Medicaid liens are not as cumbersome to resolve as Medicare liens. Attorneys can obtain the final lien amounts more quickly.

The burden of verifying whether a lien exists lies on the lawyer and not on the government to notify them about the lien. Even though you never receive notification about a lien, the government will still come collecting. Part of the attorney’s job in a personal injury case is to verify whether a client has an existing Medicare of Medicaid lien.

If your medical treatment was covered by Medicare or Medicaid, you can expect to reimburse the government for the amounts it paid. Reimbursement is not a matter of “if” but “when.”

At Wells, Purcell & Kraatz, our Texas personal injury lawyers work diligently to maximize the compensation our clients recover. We handle Medicare and Medicaid subrogation and other aspects of your claim when we take on your case. To discuss personal injury, call our Fort Worth law office at (800) 882-4529 or contact us online.

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