HensonFuerst | Injury Law Blog

Imagine that you have been in a car wreck and are unable to work because of your injuries… or that you have ongoing hospital bills due to medical malpractice. You’ve done everything right. You took your case to court and won a settlement for your losses. How long do you think it might take to receive the money you need to pay your mortgage or other bills?

If you are younger than age 65, you could receive your settlement check within weeks. That sounds right, right? Here’s the problem: If you are age 65 or older, your settlement check could be delayed by years. Yes…years. The difference is due to the red-tape run-around involving something called the Medicare Secondary Payer System (MSP).

The MSP was the product of good intentions. It was designed to help keep Medicare solvent by reimbursing the Medicare Trust Fund if another insurance or compensation source is available to pay for health care costs. The timeline (ideally) would go like this:

1. An injury occurs.
2. The medical bills are paid by Medicare.
3. A lawsuit is filed.
4. A lawsuit is won.
5. Medicare is contacted.
6. Medicare bills are tallied.
7. Medicare is reimbursed from the settlement money.
8. The remainder of the settlement goes to the injured person.
9. Other bills get paid and justice is done.

Again, that’s the ideal. In reality, this is what happens (differences are highlighted):

1. An injury occurs.
2. The medical bills are paid by Medicare.
3. A lawsuit is filed.
4. A lawsuit is won
5. Medicare is contacted. (So far, so good.)
6. Medicare sits on the request to tally the bill.
7. Medicare sits on the request to tally the bill.
8. Medicare sits on the request to tally the bill.
9. Medicare sits on the request to tally the bill.
10. Medicare sits on the request to tally the bill. (ad infinitum)
11. Other bills don’t get paid; justice is not done.

The funds that have been won in a lawsuit can be tied up for years due to the red-tape and inefficiencies of the MSP system. And remember, we’re talking about senior citizens–many of them die before they see a dime of the money that could improve their lives.

What Is Being Done?

There is currently a Bill before Congress that would streamline the process of Medicare reimbursement. The Bill (HR 4796: The Medicare Secondary Payer Enhancement Act) will do several things. Most importantly, it will require that Medicare respond to requests for recovery information within 60 days… that Medicare develop an appeals process for repayment determinations…and that there be a 3-year statute of limitations, so that Medicare can’t ignore injured seniors forever.

One has to wonder why the system would allow this kind of bureaucracy or incompetence to continue. Don’t they want funds repaid in a timely manner? Who benefits from keeping the law in place as it is? It seems like no one: The bill was introduced in March 2010 by Reps. Patrick Murphy (D-Pa.) and Tim Murphy (R-Pa.). It is co-sponsored by 26 other Representatives–Democrats and Republicans–and is backed by a varied group of organizations and businesses, including Walmart, the Defense Research Institute, the American Insurance Association, and Safeway.

HensonFuerst also supports the bill. We have seen many of our clients suffer needlessly–additional suffering on top of their injuries–because of the current difficulties with Medicare reimbursement. If you want to read the full bill and see its status, click here: http://www.govtrack.us/congress/bill.xpd?bill=h111-4796

And if you want to send a message of support to your Representative in Congress, go to the website for People Over Profits (http://www.peopleoverprofits.org), or click here to be taken to their dedicated web page: Support HR 4796.

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