From whom can CMS recover funds if Medicares interests are ignored in a workers compensation or liability case?
A16. CMS has a direct priority right of recovery against any entity including an injured party, provider, supplier, physician, attorney, state agency, or private insurer that has paid or received any portion of the settlement proceeds whether directly or indirectly. CMS also has a subrogation right with respect to any such third party payment. See, for example, ’42 CFR 411.24(b), (e), and (g) and ’42 CFR 411.26. Comment: This right of recovery clearly applies to any conditional Medicare payments made prior to the settlement, however there is no clarity as to whether CMS has a direct right of recovery against any entity for payments Medicare may make for services provided “after” the settlement. Q17. If a current Medicare beneficiary has outstanding workers’ compensation or liability related medical services or prescription drug claims that were not paid prior to the settlement will Medicare or the Medicare Set-aside pay those claims? A17. No, Medicare cannot pay because it is secondary
Related Questions
- Does CMS propose that a Medicare Set-aside be established in situations that involve both a workers compensation and a liability claim?
- Does CMS require that a Medicare Set-aside be established in situations that involve both a workers compensation and a liability claim?
- From whom can CMS recover funds if Medicares interests are ignored in a workers compensation or liability case?
