Does the Medicare program have a claim against a lump sum workers= compensation payment before an injured party=s Medicare entitlement commences?
A13. No. Medicare cannot make a formal determination until the injured party actually becomes entitled to Medicare. However, once the injured party becomes Medicare entitled, Medicare payment may not be made to the extent of Medicare’s interests in the lump sum payment as outlined pursuant to ‘ 42 CFR 411.46 or if a Medicare Set-aside has been established according to that Medicare Set-aside that adequately considers Medicare’s interests. There is no current similar regulation specifically addressing liability settlements however with liability settlements which are interpreted to include compensation for future medical services and/or prescription drug therapy charges similar Medicare arguments can be anticipated.
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