Even though it isn't exactly a California subject, we've been keeping an eye on the ramping up by companies and the Centers for Medicare and Medicaid Services (CMS) in the area of MMSEA and Medicare recovery, because of CBL's belief that MMSEA is going to change the way settlements are reached in every case involving a Medicare eligible personal injury plaintiff. You can find previous posts, citations and a white paper here, here, here, here, here and here.
Reporting and recovery both present uncharted waters. Lawyers, clients, RRE's and everybody else can only hope to get as much advice as they can in the hopes that they won't miss issues. So, with this in mind, last month I "attended" a webinar on MMSE issues put on by Risk and Insurance Management Society, Inc. called "Not Getting it Right Can Cost You: Medicare Secondary Payer Reporting." The presenters were Roy Franco, the Risk Management Strategies Director for Safeway and Katie Fox, Compliance & Resolution Manager for MedInsights. While much of what they covered was introductory (and similar to what you'll find in CBL's posts and white paper), they raised some issues that I hadn't thought of before:
- A plaintiff attorney may urge his Medicare-eligible client to keep injury-related bills out of the Medicare system. But neither the attorney, nor the plaintiff, not the defendant or its attorney can depend on this. Providers' back offices are used to sending bills off to anyone and everyone who might pay, and inadvertant billing of Medicare is common. So Medicare's interests have to be protected in every case where it might have made a payment.
- Once the government begins its recovery process, the communications from the government are not designed to provide much, if anything, in the way of useful information. It isn't unusual for a large insurance company to receive an invoice from the Department of the Treasury indicating that it is for payments related to "Joseph Smith," with no other identifying information and no information as to what the claim is for. And if it doesn't get paid within sixty days -- because nobody has any idea what it is for -- the next communication comes from the Justice Department.
- Finally, RRE's should not get to comfortable with the fact that CMS had delayed reporting until next year. As CBL has pointed out, this delay conflicts with the statute, and it won't be at all surprising if, once the system is at least to some extent up and running, CMS directs RRE's to go back and report settlements starting July 1, 2009.
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